Medical Claims Examiner II

Job not on LinkedIn

🔥 0 minutes ago

❄️ Minnesota – Remote

❄️ Minnesota – Remote

💵 $22 - $29 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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Gravie

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2013

🏥 Healthcare

🛡️ Insurance

🤝 B2B

💰 $150M Private Equity Round - Gravie on 2025-05

Healthcare • Insurance • B2B

Gravie is a benefits and health insurance solutions company that helps small and midsize employers, brokers, and employees access and administer more flexible, affordable health benefits. Its flagship offerings include Comfort (a level-funded health plan), Gravie ICHRA (Individual Coverage Health Reimbursement Arrangement administration), Gravie Pay (support for healthcare costs), and Gravie Care; the company focuses on enabling SMBs to offer individualized, lower-cost coverage and simplifying benefits administration.

📋 Description

• Review, investigate, and verify coverage to ensure proper processing of medical claims • Process complex claim scenarios involving COB, Prior Authorization, Claim Adjustments, HRA, Transplant Claims, and High Dollar Claims Processing • Review claims queues and address claim nuances with appropriate parties • Serve as a go-to resource for other Examiners and help resolve claims issues • Meet department metrics and quality standards • Document and communicate complex claims issues • Provide feedback on workflow gaps, process improvements, system enhancements, and training needs • Support special projects including inventory management, process development, and auditing

🎯 Requirements

• High School Diploma • 4+ years of experience processing, adjusting, and/or analyzing medical claims, preferably in a TPA environment • Strong knowledge of CPT/HCPC and ICD-10 code rules • Ability to set priorities, manage time, and work independently • Functional comfort with Zoom, Microsoft Teams, or Google Meets • General knowledge of CMS claims submission regulations • Strong collaboration and communication skills within a team setting

🏖️ Benefits

• Alternative medicine coverage • Flexible PTO • Up to 16 weeks paid parental leave • Paid holidays • 401k program • Transportation perks • Education reimbursement • 2 days of paid paw-ternity leave • Standard health and wellness benefits