Claims Examiner II

🔥 15 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

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👻 Ghost score 10%

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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

• Adjudicate healthcare claims using specified policies and procedures • Review claims-processing system data to determine whether services were appropriate and benefit coverage criteria were met • Review adjudication system edits and determine whether to pay claims or line items • Process assigned claims according to client-specified guidelines or team-leader direction • Meet productivity targets and financial and procedural accuracy standards • Mentor junior team members • Collaborate on special projects, including process documentation, training, quality audits, client surge activity, and other assigned work • Communicate with management regarding issues and concerns and take preventive measures to ensure processing accuracy and quality • Participate in projects involving provider data, authorizations, enrollment, or other activities

🎯 Requirements

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

🏖️ Benefits

• Full-time, permanent employment • Remote work environment • May require travel dependent on company needs • Reasonable accommodations for individuals with disabilities • Equal opportunity employer committed to workforce diversity