Claims Examiner

A company is looking for a Claims Examiner I to handle processing and adjudication for healthcare claims.

Key Responsibilities

Process and adjudicate claims for medical, dental, vision, and mental health services

Conduct claims research, verify medical necessities, and manage overpayment investigations

Resolve claims appeals and verify correct plan loading

Required Qualifications

2+ years of related work experience in claims examination or adjudication

High school diploma or GED

Knowledge of CPT and ICD-9 coding

Familiarity with COBRA, HIPAA, and coordination of benefits

Proficiency in Microsoft Windows and related software for medical coding