Claims Examiner

📋 Description

• Evaluate and process medical claims, ensuring precise coding, data entry, and the application of suitable reimbursement strategies.

• Confirm patient eligibility, provider credentials, and coverage information to ensure accurate claims handling.

• Liaise with internal resources and stakeholders to address claim discrepancies, seek additional information, or clarify issues.

• Engage in continuous training and professional development activities.

• Keep accurate and comprehensive records of claims processing activities.

• Analyze claim forms and their supporting documents.

• Assess eligibility and verify the accuracy of data.

• Solicit additional information when necessary.

• Manage claims processing from start to finish.

• Identify and escalate complex or atypical claims for further examination or investigation.

⛳️ 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 calculations.

• Knowledge of medical terminology is highly preferred.

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

• Basic proficiency in MS Office applications.

• Ability to work autonomously as well as collaboratively within a team.

• Strong time management skills.

• Proficient written and verbal communication skills.

• Keen attention to detail.

• Must exhibit sound decision-making abilities.

🏝️ Benefits

• Remote work opportunities available.

• Equipment will be provided.

• Paid training designed to ensure your success.

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

• Paid Time Off (PTO) included.

• 7 paid holidays offered.

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