Claims Examiner II

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

📋 Description

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

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

• Assess claims processing system data to verify the appropriateness of services and ensure benefit coverage criteria are satisfied.

• Evaluate edits in the adjudication system to decide on the payment of claims and/or line items.

• Provide mentorship to junior team members.

• Collaborate on special initiatives, which may include process documentation, training, quality audits, and support for surge activities.

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

• Implement preventive strategies to guarantee processing accuracy and quality.

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

⛳️ Requirements

• A High School diploma is required.

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

• Strong understanding of and ability to analyze 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.

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

• A willingness to acquire new skills.

• Ability to work collaboratively in a team setting.

• Strong work ethic.

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

• Self-motivated and quick to learn.

• Competence in working across multiple time zones.

• Candidates may be subject to a pre-employment criminal background check.

🏝️ Benefits

• Remote work environment.

• Hybrid or remote work options available.

• Travel may be required depending on company needs.

• Reasonable accommodations provided for individuals with disabilities.

• Commitment to equal opportunity and workforce diversity.