Claims Examiner

Job Summary

A company is looking for a Claims Examiner (remote).

Key Responsibilities

• Review and process claim submissions for appropriateness and completeness according to guidelines
• Adjudicate claims, determining appropriate payments or denials based on coverage guidelines
• Maintain internal customer relations and ensure accurate claim information is updated as necessary

Required Qualifications

• High School diploma or GED required
• Minimum of two to three years of Medicaid or Commercial claims payer processing experience
• Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA, and UB92 Codes
• Experience in navigating multiple systems using dual monitors
• Proficient in Microsoft Office - Excel, Word, and Outlook