Claims Examiner II - Remote

Overview

The Claims Examiner II is responsible for the timely review, investigation, and adjudication of all types of Medicaid, Medicare, group and individual medical, dental, and mental health claims.

In Short

• Adjudicate medical, dental, and mental health claims.
• Re-adjudicate, adjust, or correct claims as needed.
• Meet quality and production standards.
• Provide excellent customer service.
• Collaborate with Claims teams and other departments.
• Determine eligibility and benefit levels.
• Investigate third-party issues.
• Generate necessary letters and documents.
• Identify ways to improve quality and productivity.
• Stay updated with changing processes and policies.

Requirements

• Minimum 2 years’ experience as a Medical Claims Examiner.
• Knowledge of medical coding and terminology.
• Experience with QNXT, Facets, Epic systems preferred.
• Strong analytical and problem-solving skills.
• Ability to perform fast and accurate data entry.
• Good communication skills.
• Basic computer skills, including Microsoft Outlook, Word, and Excel.
• Detail-oriented with strong organizational skills.
• Able to work in a fast-paced environment.
• Ability to accept direction and feedback.

Benefits

• Competitive pay and bonus opportunities.
• Comprehensive benefits package including medical, dental, and vision insurance.
• 401(k) contributions and retirement plan with employer contributions.
• PTO and paid holidays.
• Employee assistance program and wellness program.
• Flexible spending accounts and health savings accounts.
• Voluntary life and other supplemental benefits.
• Paid State Sick Time.
• Opportunities for career advancement.
• Supportive working environment focused on health equity.