Medical Claims Examiner

A company is looking for a Medical Claims Examiner. Key Responsibilities Enter and review claims data for correct adjudication based on patient benefit coverage and provider contracts Investigate claims to verify member eligibility and benefit coverage, and deny unauthorized claims as per guidelines Process various types of claims ensuring payment and denial accuracy and compliance with turnaround times Required Qualifications Minimum one year of experience in healthcare claims processing or adjudication preferred Understanding of health claims processing/adjudication Familiarity with medical terminology and ICD-9 & ICD-10 Basic MS Office computer skills Ability to work independently or as part of a team

Mar 5, 2025 - 05:47

A company is looking for a Medical Claims Examiner. Key Responsibilities Enter and review claims data for correct adjudication based on patient benefit coverage and provider contracts Investigate claims to verify member eligibility and benefit coverage, and deny unauthorized claims as per guidelines Process various types of claims ensuring payment and denial accuracy and compliance with turnaround times Required Qualifications Minimum one year of experience in healthcare claims processing or adjudication preferred Understanding of health claims processing/adjudication Familiarity with medical terminology and ICD-9 & ICD-10 Basic MS Office computer skills Ability to work independently or as part of a team