Medical Claims Examiner II

Job Description

Job Description

We are looking for a skilled Medical Claims Examiner II to join our team in Roseburg, Oregon. This Contract-to-permanent position involves analyzing and processing healthcare claims to ensure compliance with organizational policies and industry regulations. The role requires excellent attention to detail and the ability to collaborate effectively with healthcare providers, insurance representatives, and other stakeholders.

Responsibilities :

• Review and assess complex medical claims to verify coverage, eligibility, and payment accuracy in accordance with contractual agreements.
• Analyze medical records, billing statements, and supporting information to validate claims and ensure compliance with established standards.
• Investigate discrepancies in claims, resolve billing issues, and identify fraudulent activities.
• Communicate clearly and professionally with healthcare providers, patients, and insurance representatives to address claims-related inquiries.
• Collaborate with internal teams, such as billing, collections, and compliance, to resolve escalated claims and investigate claim histories.
• Maintain comprehensive electronic records of claims and related documentation for auditing and quality assurance purposes.
• Stay informed on healthcare billing practices, insurance policies, and regulatory updates to ensure adherence to current standards.
• Propose enhancements to existing processes to improve the efficiency and accuracy of claims handling.
• 3–5 years of experience in healthcare claims processing or a related field.
• Strong knowledge of medical billing codes, including ICD-10 and CPT, and insurance policy terminology.
• Familiarity with healthcare claim submissions and adjudication processes.
• Proficiency in using claims management software or Electronic Medical Records (EMR) systems.
• Exceptional analytical and problem-solving abilities.
• Excellent verbal and written communication skills.
• Understanding of healthcare regulations, billing practices, and compliance standards.
• Ability to handle inbound calls and provide administrative support as needed.