Medical Claims Examiner

Job Summary

A company is looking for a Medical Claims Examiner III.

Key Responsibilities

• Support team discussions and aid in claims issue resolution
• Process and adjudicate claims in accordance with established policies and guidelines
• Facilitate training and development for team members and assist in departmental workflow improvements

Required Qualifications

• High School Diploma
• 6+ years of experience in processing or analyzing medical claims, preferably in a TPA environment
• Strong knowledge of CPT/HCPC and ICD-10 code rules
• General knowledge of CMS claims submission regulations
• Proven ability to develop and implement medical claims processes