Claims Examiner

📋 Description

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

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

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

• Engage in ongoing training and professional development activities.

• Keep accurate and detailed records of claims processing activities.

• Examine claim forms and supporting documentation.

• Assess eligibility, verify the accuracy of data, and request additional information when necessary.

• Manage claims from start to finish.

• Recognize and escalate complex or unusual claims for further examination or investigation.

• Address more complex claims involving multiple services and providers.

⛳️ Requirements

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

• Knowledge of health claims processing and adjudication.

• Capability to perform basic to intermediate mathematical computations.

• Proficiency in medical terminology is highly preferred.

• Familiarity with ICD-9 and ICD-10 coding systems.

• Basic skills in MS Office applications.

• Ability to work independently as well as collaboratively within 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 options available.

• Necessary equipment will be provided.

• Paid training to ensure your success.

• Comprehensive benefits package: 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.