Claims Examiner
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Job Description
Claims Processor processing medical claims for Imagenet LLC, a healthcare technology company. Ensuring compliance with payer requirements and maintaining accurate claims records in a remote setting.
Responsibilities:
- Review and adjudicate medical claims , ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies.
- Verify patient eligibility , provider credentialing, and coverage details to facilitate accurate claims processing.
- Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues.
- Participate in ongoing training and professional development activities.
- Maintain accurate and detailed records of claims processing activities.
- Review claim forms and supporting documents
- Determine eligibility, verify data accuracy
- Request additional information when needed
- Process claims end-to-end
- Identify and escalate complex or unusual claims for further review or investigation.
- Participate in ongoing training and professional development activities.
- Handle more complex claims with multiple services, providers
Requirements:
- At least 1-2 years of experience working closely with healthcare claims or in a claims processing/adjudication environment
- Understanding of health claims processing/adjudication
- Ability to perform basic to intermediate mathematical computation routines
- Medical terminology strongly preferred
- Understanding of ICD-9 & ICD-10
- Basic MS office computer skills
- Ability to work independently or within a team
- Time management skills
- Written and verbal communication skills
- Attention to detail
- Must be able to demonstrate sound decision-making skills
Benefits:
- Remote work offered
- Equipment provided
- Paid training to set you up for success
- Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
- Paid Time Off (PTO)
- 7 paid holidays
- A supportive team and a company that values internal growth
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