Claims Examiner II

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

📋 Description

• Report directly to the Claims Team Leader.

• Evaluate healthcare claims in accordance with established policies and procedures.

• Analyze data within the claims processing system to verify the appropriateness of services and compliance with benefit coverage criteria.

• Assess adjudication system edits to decide whether claims or individual line items are eligible for payment.

• Process assigned claims based on client-specific guidelines or directions from the team leader.

• Achieve productivity targets while maintaining financial and procedural accuracy standards.

• Provide mentorship to junior team members.

• Collaborate on various projects, including process documentation, training initiatives, quality audits, surge activity support, and other designated tasks.

• Communicate effectively with management regarding issues and concerns, and implement preventive measures to ensure processing accuracy and quality.

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

• Utilize video technology to work across multiple time zones.

⛳️ Requirements

• High school diploma is a must.

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

• Strong comprehension and analytical skills for evaluating claim data.

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

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

• Proficiency in ICD-10, CPT, and HCPCS coding is advantageous.

• Eagerness to acquire new skills.

• Ability to work collaboratively within a team.

• Demonstrated strong work ethic.

• Capacity to adapt swiftly to a dynamic work environment.

• Self-motivated individual with a quick learning ability.

• Effective team player.

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

🏝️ Benefits

• Full-time, permanent position.

• Remote work setting.

• Options for hybrid or fully remote work.

• Travel may be necessary based on company requirements.

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