Claims Examiner II

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

📋 Description

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

• Achieve productivity goals while ensuring financial accuracy and adherence to procedural standards.

• Analyze data from the claims-processing system to verify the appropriateness of services and whether benefit coverage criteria have been satisfied.

• Evaluate edits from the adjudication system to decide if claims or line items are payable.

• Provide mentorship to junior team members.

• Collaborate on special projects, which may include process documentation, training, quality audits, and managing surge activities.

• Maintain open communication with management regarding any issues or concerns that arise.

• Implement preventive measures to promote processing accuracy and quality.

• Engage in projects related to provider data, authorizations, enrollment, or other designated activities.

• Report directly to the Claims Team Leader.

⛳️ Requirements

• A High School diploma is required.

• 1 to 3 years of experience in healthcare claims processing.

• Strong understanding and analytical skills regarding claim data.

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

• Knowledge of CPT, HCPCS, ICD-10, UB04, CMS 1500, authorizations, and healthcare concepts is essential.

• Experience with ICD-10, CPT, and HCPCS coding is an advantage.

• Eagerness to acquire new skills.

• Ability to work collaboratively within a team.

• Strong work ethic is essential.

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

• Self-motivated individual with a quick learning ability.

• Team player with strong collaboration skills.

• May be required to pass a pre-employment criminal background check.

• Geographic responsibility: Remote, within the US.

🏝️ Benefits

• Work in a remote environment.

• Enjoy a hybrid or remote work setting that accommodates multiple time zones.

• Travel may be necessary based on company needs.

• Reasonable accommodations are available for individuals with disabilities.

• We are an equal opportunity employer dedicated to workforce diversity.