Job Description

Medical Claims Examiner I

Location: Remote, US only

Work authorization: US Citizen or US Green Card only

Hours: Mon- Fri 7:30AM -3:30 PM EST or 8:00 AM - 4:30 PM EST

Compensation: $20 per hour

Position Summary: The Medical Claims Examiner I position is responsible for processing medical, dental and vision claims. In this pivotal role, you will demonstrate skills in problem solving and benefit plan interpretation. This includes providing comprehensive customer support, addressing inquiries and resolving issues with professionalism and efficiency. You will play a crucial role in fostering positive customer relationships as well as ensuring every customer feels valued and supported.

Additional Job Duties:

• Review and process medical claims according to Plan guidelines within established turnaround time frames.

• Interpret medical plan to assure system is coded correctly.

• Review claims for legitimacy and accuracy

• Meet production and quality standards set for examiners

• Work Customer Service inquiries related to claim questions.

• Review correspondence submitted by members and providers and adjust all related claims if the additional documentation submitted warrants adjustment

Requirements:

• High School Diploma or GED required

• Minimum 1 year of experience with Medical claims

• Demonstrated skills in problem solving and benefit plan interpretation

Preferences:

• Knowledge of CPT codes, ICD9/ICD10 codes and/or medical terminology is a plus