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Claims examiner Jobs in Dallas, TX

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Claims examiner • dallas tx

Last updated: 1 day ago

Claims Examiner

Sigma Systems, Inc.Irving, Texas, United States
Full-time +1Full-time +1
Quick Apply

Claims Examiner Irving, TX 3 Months contract.Work Schedule: 5 Days - 8 Hours.The Claims Examiner Senior is responsible for reviewing, analyzing, researching, and resolving complex medical claims in... Show more

Senior Medical Claims Examiner

MDA EdgeIrving, TX, United States
Full-timeFull-time

The Senior Claims Examiner is responsible for reviewing, analyzing, researching, and resolving complex medical claims in accordance with claims processing guidelines and desktops, as well as, ensur... Show more

Claims Examiner - Liability | Jurisdiction - All states | Licensing: Required - Hybrid

SedgwickIrving, TX, United States
$63,000.00–$88,000.00 yearly$63,000.00–$88,000.00 yearly
Full-timeFull-time

By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected.We invite you to grow your c... Show more

Claims Examiner - Claims Processing

CHILDREN'S HOSPITAL OF SAN ANTONIOIrving, TX, United States
Full-timeFull-time

The Claims Examiner is responsible for processing UB and CMS 1500 claims, performing data entry and claim pend issue resolution within the quality and production requirements.Adjudicate claims at a... Show more

Claims Examiner - Auto

MindlanceIrving, TX, United States
Full-timeFull-time

Auto Casualty Claims Specialist.Auto casualty experienced in commercial auto liability and coverage.Bodily injury handling experience to include demonstrable mid to high level injury handling.Licen... Show more

Claims Examiner

Arthur LawrenceIrving, TX, US
Full-timeFull-time

Schedule: Monday to Friday, 8:00 AM – 4:00 PM.Work Setup: Hybrid (1–2 days on-site per week).Review and process standard or less complex insurance claims (electronic and written).Respond to custome... Show more

Claims Examiner - Auto - Remote / Telecommute

Cynet SystemsIrving, TX, United States
Full-timeFull-time

Bachelors degree from an accredited college or university preferred.Professional certification as applicable to line of business preferred.Secure and maintain the State adjusting licenses as requir... Show more

Field Examiner - Business Credit

PNCDallas, TX, United States
Full-time +1Full-time +1

At PNC, our people are our greatest differentiator and competitive advantage in the markets we serve.We are all united in delivering the best experience for our customers.We work together each day ... Show more

Senior Claim Examiner I

AmTrust Financial ServicesDallas, TX, United States
Full-timeFull-time

We are seeking experienced professionals to join our Workers' Compensation team as a Senior Claim Examiner.Both positions play a critical role in managing workers compensation claim files and ensur... Show more

Claims Examiner - Auto

SynecticsIrving, TX, United States
Full-timeFull-time

Seeking a Claims Examiner to analyze and process commercial auto transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.An... Show more

Claims Examiner Senior 160

TalentBurstIrving, TX, United States
$24.00 hourly$24.00 hourly
Full-timeFull-time

Location: Irving, TX 75039 - Onsite Shift: 8 AM - 5 PM - Monday-Friday Duration: 13+ Weeks Pay Rate: $24/hr.Proof of education; High School Diploma Minimum of 3 years' experience processing medical... Show more

Senior Claims Examiner, Professional Liability

Arch Capital GroupDallas, TX, United States
$111,100.00–$172,465.00 yearly$111,100.00–$172,465.00 yearly
Full-timeFull-time

Professional Liability Claims Manager.With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communit... Show more

Associate FCA Examiner

US Government Jobs - Other AgenciesIrving, TX, United States
Full-timeFull-time

Student Trainee (Associate FCA Bank Examiner).As a Student Trainee (Associate FCA Bank Examiner), you will be responsible for gaining hands-on experience in financial institution examination work.C... Show more

Associate FCA Examiner

US Government JobsIrving, TX, United States
Full-timeFull-time

This position is part of FCA's Pathways Program.This paid summer internship is located in the Office of Examination's Staff Development Division that develops and prepares Associate FCA Bank Examin... Show more

Claims Examiner - Claims Processing

CHRISTUS Spohn Health SystemIrving, TX, United States
Full-timeFull-time

The Claims Examiner is responsible for processing UB and CMS 1500 claims, performing data entry and claim pend issue resolution within the quality and production requirements.Adjudicate claims at a... Show more

Claims Examiner - Workers Compensation

VytwoDallas, TX, US
$35.00 hourly$35.00 hourly
Full-timeFull-time

Title: Claims Examiner - Workers Compensation (1431041).Mandatory: Work comp claims handling experience is needed; loss time.Minimum 3+years of relevant WC experience required.To analyze complex or... Show more

Senior Workers' Compensation Claims Examiner - Federal Claims

AIGDallas, TX, United States
$73,000.00–$96,000.00 yearly$73,000.00–$96,000.00 yearly
Full-timeFull-time

Senior Workers Compensation Claims Examiner.At AIG, we are reimagining the way we help customers to manage risk.Join us as a Senior Workers Compensation Claims Examiner to play your part in that tr... Show more

Claims Examiner Auto

IconmaIrving, TX, United States
Full-timeFull-time

Our Client, a Business Solutions company, is looking for a Claims Examiner Auto for their Irving, TX location.To analyze and process commercial auto transportation claims by reviewing coverage, co... Show more

Claims Examiner I

Blue Cross Blue Shield of FloridaIrving, TX, United States
Full-time +1Full-time +1

WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans.Anticipated Training ... Show more

Workers Compensation Claims Examiner III

TRISTAR Insurance GroupIrving, TX, United States
$80,000.00–$85,000.00 yearly$80,000.00–$85,000.00 yearly
Full-timeFull-time

Workers Compensation Claims Examiner III.Hybrid Dallas - Irving, TX 75038.Salary/year Level Experienced Position Type Full Time Job Shift Day Education Level High School Diploma or GED Travel Perc... Show more

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Claims Examiner

Claims Examiner

Sigma Systems, Inc.Irving, Texas, United States
1 day ago
Job type
  • Full-time
  • Temporary
  • Quick Apply
Job description

9151476 - Claims Examiner Irving, TX 3 Months contract
Sigma Inc. is currently looking for a Claims Examiner in Irving, TX.

Shift Timings: Work Schedule: 5 Days - 8 Hours

Summary:

  • The Claims Examiner Senior is responsible for reviewing, analyzing, researching, and resolving complex medical claims in accordance with claims processing guidelines and desktops, as well as, ensuring compliance with federal regulations.
  • This role works in conjunction with Business Configuration, Network Management, Provider Data, Complaints, Appeals and Grievances as well as other operational departments to ensure validation and quality assurance of claims processing.

Responsibilities:

  • Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
  • Analyze medical claim information and take appropriate action for payment resolution in accordance with policies and procedures, desktops, processing guidelines, and federal regulations.
  • Process medical claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms from facilities, physicians, Home Health, Durable Medical Equipment providers, laboratories, etc.
  • Work claim projects resulting from overpayments or underpayments related to manual processing errors, benefit updates, and/or contract, fee schedule changes.
  • Process provider refunds, reconsiderations, and direct member reimbursements.
  • Process medical claim adjustments, recovery of claim overpayments, and execution of claim batch adjudication.
  • Solve moderately complex claims and escalate issues to the Claims Team Lead, Supervisor or Manager.
  • Assist with database improvements and testing for system upgrades, conversions, or implementation of new processes.
  • Serves as a resource to assist with training new associates, retraining current associates on new/updated desktops/policies and reports staff progress, deficiencies, and training needs to management.
  • Sets high standards of performance and promotes teamwork to achieve established team goals, while maintaining a positive, professional attitude.
  • Contacting/responding to internal and external customers for resolution on claim issues.
  • Assist claims leadership to identify claim trends, gaps in workflow and create/update desktops and policies and procedures.
  • Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks/goals.
  • Must be able to organize and prioritize work to meet deadlines.
  • Have good judgment, initiative, and problem-solving abilities.
  • Attention to detail is critical to ensure timely and accurate processing of claims.
  • Consistently meet established productivity and quality standards.
  • Follow CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent, or detect unauthorized disclosure of Protected Health Information (PHI).
  • Performs other duties as assigned by management to support claims functions, which are focused on achieving both departmental and organizational objectives.
  • Must be knowledgeable about medical terminology, CPT, HCPCS, ICD-10, Revenue Codes, CMS-1500 and CMS-1450/UB-04 claim forms and reimbursement methodologies.
  • Must have excellent written, verbal, organizational and interpersonal communication skills.
  • Must be proficient in Microsoft Office, Power Point, Excel, Word, Outlook, spreadsheet, and database skills.


Job Requirements:

  • Associate's degree or equivalent job-related experience required.
  • Minimum of 3 years' experience processing medical claims in the healthcare industry.
  • Prior experience working with managed care, Medicare, Medicare Advantage, Health Exchange, and TRICARE are highly desirable.