Claims Examiner III

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $40k - $44k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 according to client-specified guidelines or team-leader direction • Meet productivity targets and financial and procedural accuracy standards • Review claims-processing data to determine whether services were appropriate and coverage criteria were met • Review adjudication-system edits and determine whether to pay claims or line items • Mentor junior team members • Collaborate on special projects, including process documentation, training, quality audits, and surge 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 activities • Perform other duties as assigned

🎯 Requirements

• High School degree required • 3–5 years of healthcare claims processing experience • Solid understanding of and ability to analyze claim data • Knowledge of physician billing and hospital coding, including ICD-10, HCPC, and CPT-4 • Knowledge of medical terminology and authorization requirements • 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 • Ability to work across multiple time zones in a hybrid or remote work environment • Candidates may be required to complete a pre-employment criminal background check

🏖️ Benefits

• Annual US base salary range of $40,000 to $44,000 • Remote work environment • Work across multiple time zones • Potential travel based on company needs • Reasonable accommodations for individuals with disabilities • Equal opportunity employer committed to workforce diversity