A company is looking for a Claims Examiner I who will handle processing and adjudication for healthcare claims.
Key Responsibilities
Process and adjudicate medical, dental, vision, and mental health claims
Conduct claims research and verify medical necessities and coverage under policy guidelines
Facilitate claims investigations, negotiate settlements, and manage overpayment reviews
Required Qualifications
2+ years of related work experience in claims examination / adjudication
High school diploma or GED
Knowledge of CPT and ICD-9 coding
Familiarity with COBRA, HIPAA, and coordination of benefits
Proficiency in using Microsoft Windows, Word, Excel, and medical CPT coding programs
Claims Examiner • Santa Rosa, California, United States
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