Health Claims Examiner

A company is looking for a Health Claims Examiner I.

Key Responsibilities

Review medical documents to ensure completeness and validity for claim adjudication

Determine covered services and calculate benefits due based on policy provisions

Convey adverse claim decisions and maintain patient privacy in accordance with HIPAA standards

Required Qualifications

Bachelor's degree preferred or 1-2 years related experience or equivalent combination of education and experience

Knowledge of the insurance industry and claims handling experience preferred

Experience with ICD-9 / ICD-10, CPT coding, and medical terminology

Proficiency in Microsoft Office Suite and basic computer programs

Ability to thrive in a fast-paced environment while working independently