Claims Examiner II – Provider Projects

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

📋 Description

• Process healthcare claims assigned to you according to client-defined guidelines or under the direction of your team leader.

• Achieve productivity goals while maintaining financial integrity and procedural accuracy.

• Analyze claims processing system data to assess service appropriateness and verify benefit coverage eligibility.

• Provide mentorship to junior team members.

• Engage in special projects, which may include creating process documentation, facilitating training, conducting quality audits, and supporting surge activities.

• Discuss issues and concerns with management, taking proactive steps to ensure accuracy and quality in processing.

• Participate in initiatives related to provider data, authorizations, enrollment, or other designated activities.

⛳️ Requirements

• High School diploma is mandatory.

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

• Strong ability to analyze and understand claim data.

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

• Knowledge of CPT, HCPCS, and ICD-10 coding systems.

• Understanding of UB04 and CMS 1500 forms.

• Awareness of authorizations and healthcare concepts is essential.

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

• Eagerness to learn new skills.

• Capability to work collaboratively as part of a team.

• Strong work ethic is essential.

• Ability to adjust quickly in a fast-paced work environment.

• Self-motivated and a quick learner.

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

🏝️ Benefits

• Annual base salary in the US ranging from $40,000 to $44,000.

• Flexible remote work options available.

• Hybrid or fully remote work environment.

• Potential travel may be required based on company needs.

• Reasonable accommodations will be provided for individuals with disabilities.

• Commitment to equal opportunity and workforce diversity.