Claims Examiner III - Remote

Overview

The Claims Examiner III at Gravie will support and adjudicate claims while acting as a subject matter expert in the claims process, focusing on member-centric healthcare solutions.

In Short

• Support and review claims in a best-in-class claim system.
• Act as a subject matter expert in claims processing.
• Provide coaching and support to team members.
• Conduct audits and reviews of claims processes.
• Collaborate with upper management and team members for feedback and updates.
• Meet Key Performance Indicators (KPIs) and quality expectations.
• Facilitate training and development for team members.
• Identify opportunities for improving departmental outcomes.
• Demonstrate a thorough understanding of complex claim scenarios.
• Support claims operations in system testing and configuration.

Requirements

• High School Diploma.
• 6+ years of experience in medical claims processing.
• Strong knowledge of CPT/HCPC and ICD-10 codes.
• Ability to manage time and work independently.
• Proficiency in Windows-based applications.
• Familiarity with Zoom and Microsoft Teams.
• General knowledge of CMS claims submission regulations.
• Excellent communication skills.
• Experience in managing claims inventory.
• Proven ability to develop medical claims processes.

Benefits

• Flexible PTO and paid holidays.
• Up to 16 weeks paid parental leave.
• 401k program with company match.
• Alternative medicine coverage.
• Cell phone reimbursement and transportation perks.
• Education reimbursement.
• 1 week of paid paw-ternity leave.
• Career growth opportunities.
• Mission-driven work environment.
• Competitive compensation package.