Claims Examiner II

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

📋 Description

• Process assigned healthcare claims in accordance with client-specific guidelines or under the direction of the team leader.

• Achieve productivity targets while adhering to financial and procedural accuracy standards.

• Analyze claims processing system data to assess the appropriateness of services and confirm that benefit coverage criteria are fulfilled.

• Evaluate adjudication system edits to decide whether claims or individual line items warrant payment.

• Provide mentorship to junior team members.

• Collaborate on special initiatives, including documentation of processes, training, quality audits, and support for surge activities.

• Maintain open communication with management to resolve issues and ensure accuracy and quality in processing.

• Engage in projects related to provider data, authorizations, enrollment, and other assigned tasks.

⛳️ Requirements

• High School diploma is mandatory.

• 1–3 years of experience in healthcare claims processing is essential.

• Strong understanding and capability to analyze claim data.

• Familiarity with physician practices, hospital coding, billing, and medical terminology.

• Knowledge of CPT, HCPCS, ICD-10, UB04, CMS 1500, and authorizations.

• Experience with ICD-10 CPT and HCPCS coding is advantageous.

• Willingness to acquire new skills.

• Ability to work collaboratively within a team.

• Strong work ethic is required.

• Capability to adapt swiftly to a fast-paced working environment.

• Self-motivated and a quick learner.

• Team-oriented with a strong ability to collaborate effectively.

• Candidates may need to undergo a pre-employment criminal background check.

• Ability to work across various time zones.

• Capacity to meet the physical demands associated with extended computer-based tasks, including requirements for sitting and/or standing and visual capabilities.

🏝️ Benefits

• Full-time, permanent position.

• Work in a remote environment.

• Options for hybrid or fully remote work.

• Potential travel may be necessary based on company requirements.

• Reasonable accommodations for individuals with disabilities in compliance with the Americans with Disabilities Act of 1990.

• Commitment to equal opportunity employment and workforce diversity.