Claims Examiner
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Job Description
Claims Examiner processing medical claims for MedPOINT Management, an independent physician association management company. Reviewing coding, eligibility, adjudication, discrepancies, and healthcare compliance.
Responsibilities:
- Review, analyze, and process medical claims in accordance with plan benefits and company guidelines
- Verify member eligibility, provider information, and coverage details prior to claims adjudication
- Identify and resolve claims discrepancies, duplicates, and billing errors
- Apply ICD-10, CPT, and HCPCS coding knowledge to ensure accurate claims processing
- Coordinate with providers, members, and internal departments to resolve claims inquiries
- Maintain accurate records and documentation in claims management systems
- Ensure compliance with state and federal healthcare regulations, including HIPAA
Requirements:
- 2+ years of experience in medical claims processing or claims examination
- Proficiency in ICD-10, CPT, and HCPCS coding
- Familiarity with HMO, PPO, and managed care plan structures
- Strong knowledge of EOB (Explanation of Benefits) and claims adjudication processes
- Experience with claims management software and healthcare information systems
- Excellent attention to detail and strong analytical skills
- Effective written and verbal communication skills
- Knowledge of HIPAA regulations and healthcare compliance standards
- Legal authorization to work in the US
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Vision insurance
- Wellness resources
- Company parties
- Employee discounts
- Free food & snacks
- Opportunity for advancement
- Paid time off
- Parental leave
- Savings bank
- Training & development
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