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Medical Claims Examiner Jobs

Senior Claims Examiner, Large Loss - Millennial Specialty Insurance
By Baldwin Risk Partners At , Remote
Acquire and maintain a state adjuster’s license and meet state continuing education requirements.
Has the aptitude and ability to manage homeowners total losses
Manages all claims in accordance with Best Practices.
Mentors less experienced Claims Examiners.
Bachelor’s degree or equivalent work experience
10 years of claims adjusting experience
Remote Claims Examiner Jobs
By Firstsource Healthcare At , Remote
Multiple computer application usage experience
Health claims processing experience a plus
Knowledge in the following a plus:
Specific qualifications for this medical financial services role include:
High School diploma or GED
Ability to read and interpret general business correspondence, procedure manuals, and specific plan documents
Medical Records Examiner Jobs
By Commonwealth of PA At , Home $61,868 - $93,966 a year
Minimum Experience and Training Requirements:
The Department of Human Services provides excellent benefits, pay increases, paid leave and holidays, as well as opportunities for career advancement.
Three years of professional experience in the field of medical assistance, health care services, or human services; or
An equivalent combination of experience and training.
Failure to comply with the above application requirements will eliminate you from consideration for this position.
711 (hearing and speech disabilities or other individuals).
Claims Examiner Jobs
By Firstsource Healthcare At , Remote
Health claims processing experience a plus
Multiple computer application usage experience
Work From Home Claims Analyst-(Health Care)
Here are just some of the benefits you will enjoy in this financial services role:
Specific qualifications for this medical financial services role include:
High School diploma or GED
Claims Examiner (Annuities) Jobs
By Transamerica At United States
Strong preference for prior Transamerica experience and/or knowledge of Transamerica Operations
Work closely with department manager, legal counsel, medical director, claims assistants, and other departments to gather information for contested claims.
Associate’s degree in a business field or equivalent experience
Excellent communication and customer service skills
Organizational, problem-solving and analytical skills
Review claims and outside sources used in the review.
Claims Examiner I - Medical
By EMI Health At , Salt Lake City, 84107, Ut

EDUCATION, EXPERIENCE AND OTHER SPECIFIC QUALIFICATIONS:

LANGUAGE, MATH, COMPUTER, AND REASONING SKILLS:

Assistant Medical Examiner (Medical Examiner Office) Actively Recruited - Seiu 20
By Cook County Offices Under the President At , Chicago, Il $256,081 - $294,461 a year
KNOWLEDGE, SKILLS, ABILITIES AND OTHER CHARACTERISTICS
Board certification in Anatomic, Clinical and Forensic Pathology at time of hire.
This position requires successful completion of post-offer tests, which may include a background check, drug screen and medical examination.
Must provide proof of certification or eligibility
Pre-Interview License and Certification Verification
Proficiency in Power Point and Microsoft Office® software programs.
Claims Examiner Jobs
By CSI Companies At Jacksonville, FL, United States
Investigate claims with potential fraudulent activity and review findings with management.
Education: High School diploma or equivalent.
Stay up-to-date with related state laws, anti-fraud compliance requirements, product standards, and service standards.
Employment Type: Contract to Hire
Working Hours: Standard business hours between 8am - 5pm EST
Location: Jacksonville, FL 32256 (Fully in-office)
Compensation Claims Examiner - Remote | Wfh
By Get It Recruit - Healthcare At Long Beach, CA, United States

Are you a seasoned Workers' Compensation Claims professional with a passion for helping people navigate through challenging times? Are you eager to be a part of a dynamic and supportive team that ...

(Remote) Claims Examiner - Liability
By Sedgwick At Texas, United States
Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
Professional certification as applicable to line of business preferred.
Opportunity to work in a remote or agile environment.
Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.
Claims Examiner Jobs
By Health Special Risk, Inc. At United States
Insurance knowledge/experience with medical terms and billing is a plus.
Knowledge of HIPPA, pre-existing conditions, and coordination of benefits required.
Ensure that all claims are handled in a timely manner to meet state-mandated requirements.
Minimum of 3 years of previous claims processing/adjudication experience. Trizetto QicLink or RIMS experience is a plus.
In-depth knowledge and ability to read and interpret medical policies to determine claim eligibility.
Strong detail-oriented and analytical skills.
Claims Examiner Jobs
By Sedgwick At Pennsylvania, United States
Coordinates vendor referrals for additional investigation and/or litigation management.
Refers cases as appropriate to supervisor and management.
Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
Manages the litigation process; ensures timely and cost effective claims resolution.
Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
Pl Claims Examiner - Medical Claims
By JCW At Florida, United States
Manage healthcare professional liability claims from start to finish
Minimum of two years of specialized experience in legal or medical field, preferably in professional liability
Strong interpersonal, negotiation, and analytical skills
Excellent communication, writing, and organizational skills
Conduct investigation, coverage analysis, and work with defense counsel
Control legal expenses and provide technical expertise throughout the claim process
Claims Examiner (Employee Benefits)
By Transamerica At United States
Strong preference for prior Transamerica experience and/or knowledge of Transamerica Operations
Work closely with department manager, legal counsel, medical director, claims assistants, and other departments to gather information for contested claims.
Associate’s degree in a business field or equivalent experience
Excellent communication and customer service skills
Organizational, problem-solving and analytical skills
Review claims and outside sources used in the review.
Claims Examiner Jobs
By Blue Cross and Blue Shield of Kansas At Topeka, KS, United States

Upon completion of training, extensive knowledge of business-related skills and trained product lines required.

High School graduate or equivalent required.

Claims Examiner I - Evicore - Remote
By The Cigna Group At United States
Experience with Plexus Claims Management (PCM), Truist and Cigna Portal preferred
1+ years of experience with eviCore delegated plans with working knowledge of horizon Health plan preferred
1+ years of experience in medical claims processing required
Utilize expertise to appropriately apply claim concepts, rules and departmental practices, ensuring accuracy, and timeliness of claims payment
Confirm member eligibility, claim pricing and verify authorization and service appropriateness.
Follow appropriate workflows to confirm necessary information such as member eligibility and claim pricing
Medical Records Examiner Jobs
By Commonwealth of Pennsylvania At Home, PA, United States
The Department of Human Services provides excellent benefits, pay increases, paid leave and holidays, as well as opportunities for career advancement.
Three years of professional experience in the field of medical assistance, health care services, or human services; or
An equivalent combination of experience and training.
Failure to comply with the above application requirements will eliminate you from consideration for this position.
711 (hearing and speech disabilities or other individuals).
Work hours are 7:30 am to 3:30 pm, Monday - Friday, with 30-minute lunch.
Mpl Claims Examiner Jobs
By JCW At United States
Pursuit of additional certifications such as CPCU, ARMS, or AINS designation is also valued.
The role involves driving litigation by managing the deployment and utilization of defense counsel and identifying suspected fraudulent claims.
Participation in Claims Projects, reserving roundtables, and pre-trial roundtables is required.
Please apply here, or email your resume to [email protected] for further consideration!
Facets Claims Examiner - Remote
By NTT DATA Services At Philadelphia, PA, United States
Confirm to the required regulatory and compliance requirements such as the HIPAA.
Confirm to the organizational and client training requirements
Demonstrate knowledge of internal operations and develops relationships to facilitate workflow.
Knowledge of related regulations and standards.
3+ years of full cycle claims processing experience in a Health Plan setting (Pay, Pend, Deny)
1+ year of experience processing claims in Facets
Claims - Express Claims Examiner
By The Cincinnati Insurance Companies At Fairfield, OH, United States
Customer service experience or prior management or leadership experience beneficial.
Knowledge or experience with Microsoft® Office and Excel preferred.
Deliver an excellent customer service experience through telephone and e-mail communication.
Accurate and efficient keyboarding skills.
Excellent written and verbal communication skills.
Prior experience in an office setting either fully in-office or hybrid helpful.

Are you looking for a challenging and rewarding career in the medical field? Become a Medical Claims Examiner and help ensure that medical claims are processed accurately and efficiently! Join a team of professionals dedicated to providing quality healthcare services to patients and their families.

Overview Medical Claims Examiners are responsible for reviewing and processing medical claims submitted by healthcare providers. They ensure that claims are accurate and complete, and that they meet all applicable regulations and guidelines. They also investigate any discrepancies or errors in the claims, and work with healthcare providers to resolve them. Detailed Job Description Medical Claims Examiners are responsible for reviewing and processing medical claims submitted by healthcare providers. They review claims for accuracy, completeness, and compliance with applicable regulations and guidelines. They investigate any discrepancies or errors in the claims, and work with healthcare providers to resolve them. They also review and process payments for claims, and ensure that all payments are accurate and timely. Job Skills Required
• Knowledge of medical terminology and coding
• Knowledge of medical insurance regulations and guidelines
• Excellent attention to detail
• Strong analytical and problem-solving skills
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Proficiency with computers and software programs
Job Qualifications
• High school diploma or equivalent
• Associate’s degree in medical billing and coding or related field preferred
• Certification in medical billing and coding preferred
• Previous experience in medical billing and coding preferred
Job Knowledge
• Knowledge of medical terminology and coding
• Knowledge of medical insurance regulations and guidelines
• Knowledge of medical billing and coding software
Job Experience
• Previous experience in medical billing and coding preferred
Job Responsibilities
• Review and process medical claims submitted by healthcare providers
• Ensure that claims are accurate and complete, and that they meet all applicable regulations and guidelines
• Investigate any discrepancies or errors in the claims, and work with healthcare providers to resolve them
• Review and process payments for claims, and ensure that all payments are accurate and timely
• Maintain accurate records of all claims and payments
• Monitor and update claims status in the system
• Respond to inquiries from healthcare providers regarding claims status