Remote Claims Examiner

Description: 

Responsibilities:
– Review and analyze medical claims to determine coverage and eligibility
– Investigate and gather information to support claim decisions
– Evaluate medical records, bills, and other documentation to ensure accuracy and compliance with coding standards
– Apply knowledge of medical terminology, coding systems (ICD-10, ICD-9), and billing procedures to process claims
– Communicate with healthcare providers, policyholders, and other parties to gather necessary information and resolve claim issues
– Make claim determinations based on policy guidelines and industry regulations
– Document claim decisions and maintain accurate records.

Experience:

– Previous experience as a Claims Adjuster or in a related role preferred
– Knowledge of medical office procedures, including medical coding and billing
– Familiarity with medical terminology, systems, and documentation
– Understanding of insurance policies, coverage, and claims processes
– Strong analytical skills with the ability to review and interpret complex medical records
– Excellent attention to detail and accuracy in claims processing
– Effective communication skills to interact with various stakeholders

Note: This job description is not intended to be all-inclusive. The employee may perform other related duties as negotiated to meet the ongoing needs of the organization.

Job Type: Full-time

Salary: $16.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

We are an Equal Opportunity Employer.  All qualified applicants are considered for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by federal, state or local law.