Claims Examiner

Job Summary

A company is looking for a Claims Examiner to evaluate insurance claims and determine compensation validity.

Key Responsibilities

• Evaluate and process insurance claims, reviewing policy coverage and supporting documentation
• Apply adjudication rules based on policy provisions and interpret Explanation of Benefits (EOBs)
• Ensure compliance with healthcare regulations and maintain confidentiality of sensitive information

Required Qualifications

• Knowledge of medical insurance policies and benefits eligibility
• Experience with claims adjudication and processing systems
• Familiarity with medical terminology and coding (ICD-10, CPT, HCPCS)
• Understanding of HIPAA and HITECH laws, as well as state and federal healthcare regulations
• Ability to pass a pre-employment background investigation and meet technical requirements for remote work