Claims Examiner

This is a fully remote position, open to applicants in Florida.

📋 Description

• Review and adjudicate medical claims, ensuring precise coding, data entry, and the application of suitable reimbursement methodologies.

• Verify patient eligibility, provider credentialing, and coverage specifics to ensure accurate claims processing.

• Liaise with internal resources and stakeholders to resolve claim discrepancies, request further information, or clarify issues.

• Engage in continuous training and professional development activities.

• Maintain thorough and accurate records of claims processing activities.

• Examine claim forms and accompanying documents.

• Assess eligibility and validate data accuracy.

• Request additional information as necessary.

• Manage claims from start to finish.

• Identify and escalate complex or atypical claims for additional review or investigation.

• Handle more intricate claims involving multiple services and providers.

⛳️ Requirements

• A minimum of 1-2 years of experience in healthcare claims or in a claims processing/adjudication setting.

• Familiarity with health claims processing and adjudication.

• Capability to perform basic to intermediate mathematical computations.

• Proficiency in medical terminology is highly preferred.

• Understanding of ICD-9 and ICD-10 codes.

• Basic skills in MS Office applications.

• Ability to work independently or as part of a team.

• Strong time management abilities.

• Effective written and verbal communication skills.

• Keen attention to detail.

• Must demonstrate sound decision-making capabilities.

🏝️ Benefits

• Remote work opportunities available.

• Equipment will be provided.

• Paid training to ensure your success.

• Comprehensive benefits package including Medical, Dental, Vision, Life, HSA, and 401(k).

• Paid Time Off (PTO).

• 7 paid holidays.

• A supportive team environment and a company that prioritizes internal growth.