Claims Examiner

A company is looking for a Claims Examiner to manage non-auto adjudicated claims and ensure compliance with relevant regulations.

Key Responsibilities

Accurately adjudicate claims and resolve discrepancies to contribute to overall Claims Production productivity

Maintain adherence to internal controls and compliance with applicable laws and regulations

Identify and report any unethical or fraudulent activity related to business operations

Required Qualifications, Training, and Education

High School diploma with a minimum of 3 years of relevant healthcare claims insurance administration experience

Knowledge of healthcare payer industry standards and regulations (e.g., HIPAA, ACA, CMS)

Familiarity with industry coding standards / forms (e.g., CPT4, ICD10, UB04, HCF1500)

Experience with health claims processing systems and handling confidential information

Proficiency in Microsoft Office products