Sr Claims Examiner III

Job Summary

A company is looking for a Sr. Claims Examiner III.

Key Responsibilities:

• Adjudicate healthcare claims based on specific policies and procedures
• Review claims attachments to determine medical appropriateness and benefit coverage criteria
• Review claim and line item edits in the adjudication software system for payment determination

Qualifications:

• High School degree with 3+ years of relevant professional experience in healthcare claims operations
• Willingness to learn and succeed in a new career
• Proficiency with MS Office applications, especially Word and Excel
• Knowledge of ICD-9 and ICD-10 coding, CPT and HCPCS coding, and HIPAA
• 3+ years of claims or billing operations experience in a healthcare setting