Claims Examiner

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

📋 Description

• Evaluate, analyze, and manage medical claims in alignment with plan benefits and company protocols.

• Confirm member eligibility, provider details, and coverage information before claims processing.

• Detect and rectify claims discrepancies, duplicates, and billing mistakes.

• Utilize knowledge of ICD-10, CPT, and HCPCS coding to guarantee precise claims processing.

• Collaborate with providers, members, and internal teams to address claims inquiries.

• Maintain precise records and documentation within claims management systems.

• Ensure adherence to state and federal healthcare regulations, including HIPAA compliance.

⛳️ Requirements

• Over 2 years of experience in medical claims processing or claims examination.

• Proficient in ICD-10, CPT, and HCPCS coding.

• Familiarity with HMO, PPO, and managed care plan frameworks.

• Strong understanding of EOB (Explanation of Benefits) and claims adjudication procedures.

• Experience with claims management software and healthcare information systems.

• Exceptional attention to detail and strong analytical abilities.

• Effective written and verbal communication skills.

• Knowledge of HIPAA regulations and healthcare compliance requirements.

• Legal authorization to work in the United States.

🏝️ Benefits

• 401(k)

• 401(k) matching

• Dental insurance

• Health insurance

• Vision insurance

• Wellness resources

• Company parties

• Employee discounts

• Free food & snacks

• Opportunities for advancement

• Paid time off

• Parental leave

• Savings bank

• Training & development