Claims Examiner II – Provider Projects

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $40k - $44k / year

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

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HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 Description

• Process assigned healthcare claims based on client-specified guidelines or team leader direction • Meet productivity targets and financial and procedural accuracy standards • Review claims processing system data to determine service appropriateness and benefit coverage eligibility • Mentor junior team members • Collaborate on special projects, including process documentation, training, quality audits, and surge activity support • Communicate with management about issues and concerns and take preventive measures to ensure processing accuracy and quality • Participate in projects involving provider data, authorizations, enrollment, or other assigned activities

🎯 Requirements

• High School degree required • 1–3 years of healthcare claims processing experience • Solid understanding and ability to analyze claim data • Knowledge of physician practices and hospital coding, billing, and medical terminology • Knowledge of CPT, HCPCS, and ICD-10 coding • Knowledge of UB04 and CMS 1500 • Knowledge of authorizations and healthcare concepts • ICD-10, CPT, and HCPCS coding is a plus • Willingness to learn new skills • Ability to collaborate as a team member • Strong work ethic • Ability to adapt quickly to a fast-paced environment • Self-starter and quick learner • Candidates may be required to undergo a pre-employment criminal background check

🏖️ Benefits

• Annual US base salary of $40,000 to $44,000 • Remote work environment • Hybrid or remote work environment • May require travel dependent on company needs • Reasonable accommodations for individuals with disabilities • Equal opportunity and workforce diversity commitment