Claims Examiner

📋 Description

• Review and adjudicate medical claims to ensure accurate coding, data entry, and the application of suitable reimbursement methodologies.

• Verify patient eligibility, provider credentialing, and coverage details to enable precise claims processing.

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

• Participate in continuous training and professional development initiatives.

• Maintain thorough and accurate records of claims processing activities.

• Review claim forms and accompanying documentation.

• Assess eligibility and confirm data accuracy.

• Request further information when necessary.

• Process claims from start to finish.

• Identify and escalate complex or unusual 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 environment.

• Familiarity with health claims processing and adjudication.

• Capability to perform basic to intermediate mathematical calculations.

• Medical terminology knowledge is highly preferred.

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

• Basic proficiency in MS Office applications.

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

• Strong time management skills.

• Excellent written and verbal communication abilities.

• High attention to detail.

• Must demonstrate sound decision-making skills.

🏝️ Benefits

• Remote work opportunities available.

• Equipment will be provided.

• Paid training to ensure your success.

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

• Paid Time Off (PTO).

• 7 paid holidays.

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