Claims Examiner

This is a fully remote position, open to applicants in Kansas, +1 more state.

📋 Description

• Evaluate, analyze, and validate healthcare claims submitted by policyholders or medical providers.

• Confirm that documentation, ICD-10, CPT, HCPCS coding, and data are complete and precise.

• Verify eligibility, coverage, and relevant benefits in accordance with policy terms.

• Accurately enter and process claims information into the system.

• Implement deductibles, co-pays, co-insurance, and maximum coverage limits.

• Approve or deny claims based on policy coverage and regulatory or company standards.

• Modify processed claims for corrective measures.

• Communicate with healthcare providers, patients, and internal departments to address discrepancies.

• Investigate and resolve complex or escalated claims issues.

• Ensure adherence to state and federal healthcare regulations.

• Maintain precise claims records for audits and evaluations.

• Achieve individual and team performance goals related to speed, accuracy, and quality.

• Engage in ongoing training regarding policy and technology updates.

• Monitor and manage daily reports to guarantee timely claim processing.

• Carry out other assigned responsibilities.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

• Must reside in Kansas or Missouri, or be willing to relocate as a condition of employment.

• Prior experience in healthcare claims processing, medical billing, medical terminology, or health insurance is preferred.

• Understanding of medical claim processing, medical terminology, insurance policies, and coding standards (ICD, CPT) is required.

• Strong attention to detail and excellent organizational abilities.

• Outstanding written and verbal communication skills.

• Ability to work effectively under pressure and meet deadlines.

• Critical thinking and problem-solving capabilities are essential.

• Experience with office and/or computer systems is a plus.

• Subject to pre-employment drug screening, criminal background check, employment verifications, and education verification.

🏝️ Benefits

• Paid vacation and sick leave.

• Paid maternity and paternity leave available immediately upon hire.

• Incentive pay program (EPIP).

• Health, vision, and dental insurance.

• 6 weeks paid parental leave for new mothers and fathers.

• Fertility/adoption assistance.

• 2 weeks paid caregiver leave.

• 401(k) plan matching up to 5%.

• Tuition reimbursement.

• Health and fitness benefits, discounts, and resources.

• Ongoing training and development programs.

• Flexible work environment.

• Equal employment opportunities.