Claims Examiner I

This is a fully remote position, open to applicants in Oklahoma, +1 more state.

📋 Description

• Daily processing of claims for accounts

• Handling of medical, dental, vision, and mental health claims

• Execution of claims processing and adjudication

• Conducting claims research as necessary

• Reviewing and processing insurance to ensure medical necessity and coverage in accordance with policy guidelines utilizing clinical edit logic

• Achieving and/or surpassing qualitative and quantitative production standards

• Facilitating claims investigations

• Negotiating settlements

• Interpreting medical records

• Addressing complaints from the Department of Insurance

• Authorizing payments to both claimants and providers

• Reviewing and recovering overpayments on claims

• Correcting financial histories for patients and service providers

• Tracking complaints and their resolutions using appropriate systems

• Resolving claims appeals

• Researching benefits

• Verifying correct plan loading

⛳️ Requirements

• A minimum of 2 years of relevant work experience

• Experience in medical claims and adjudication on a computerized claims payment system within the healthcare sector

• High school diploma or GED is required

• Familiarity with medical coding, including CPT, ICD10, COBRA, HIPAA, pre-existing conditions, and coordination of benefits

• Experience with various surgical procedures and the establishment of reasonable and customary fees

• Experience in processing all types of medical claims is advantageous

• Completion of medical billing and coding courses is a plus

🏝️ Benefits

• Comprehensive medical, dental, vision, life, and global travel health insurance

• Life insurance coverage

• Short- and long-term disability programs

• Leave programs designed to support personal circumstances

• Retirement Savings Plan with employer contributions and matching

• Paid time off

• Volunteer time off

• 11 holidays

• Additional voluntary benefits available

• A thorough wellness program