Medical Claims Examiner II

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

📋 Description

• Evaluate, investigate, and confirm coverage to ensure accurate processing of medical claims.

• Handle complex claim situations involving Coordination of Benefits (COB), Prior Authorization, Claim Adjustments, Health Reimbursement Arrangements (HRA), Transplant Claims, and High Dollar Claims Processing.

• Review claims queues and address claim-specific details with the relevant parties.

• Act as a primary resource for other Examiners and assist in resolving claims-related issues.

• Achieve department performance metrics and quality standards.

• Document and communicate intricate claims concerns.

• Provide insights on workflow deficiencies, process enhancements, system improvements, and training requirements.

• Assist with special projects including inventory management, process development, and audits.

⛳️ Requirements

• High School Diploma.

• A minimum of 4 years of experience in processing, adjusting, and/or analyzing medical claims, ideally in a Third-Party Administrator (TPA) setting.

• Comprehensive knowledge of CPT/HCPC and ICD-10 coding regulations.

• Ability to prioritize tasks, manage time efficiently, and work independently.

• Comfortable using Zoom, Microsoft Teams, or Google Meets.

• Basic understanding of CMS claims submission rules.

• Excellent collaboration and communication skills in a team environment.

🏝️ Benefits

• Coverage for alternative medicine.

• Flexible Paid Time Off (PTO).

• Up to 16 weeks of paid parental leave.

• Paid holidays.

• 401k retirement plan.

• Transportation benefits.

• Education reimbursement.

• Two days of paid "paw-ternity" leave.

• Standard health and wellness benefits.