Claims Examiner

🔥 0 minutes ago

❄️ Minnesota – Remote

❄️ Minnesota – Remote

💵 $28 / hour

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Smart Data Solutions

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2001

💼 Consulting

📦 Logistics

📣 Marketing

Consulting • Logistics • Marketing

Smart Data Solutions is your strategic partner in healthcare process automation, utilizing data, AI, and automation to digitally transform operations and deliver outcomes for clients. The company specializes in intelligent document management, workflow automation, and data capture, offering solutions that streamline workflows, reduce costs, and enhance customer experience. By applying machine learning and automation, Smart Data Solutions ensures a smooth process, helping healthcare entities manage claims, documents, and data efficiently.

📋 Description

• Identify, research, process, and resolve claims according to desk level procedures, business guidelines, and quality standards • Meet established productivity and timeliness standards • Conduct investigative and analytical research using critical thinking and deductive reasoning • Consult and coordinate with various teams and departments to obtain information for timely claim resolution • Transition between work groups based on business needs • Use organizational skills and available resources to meet claims processing goals • Maintain current working knowledge of client systems, procedures, forms, and manuals • Multitask and prioritize work • Participate in departmental training and calibration meetings • Establish and maintain collaborative team relationships • Review processes and share improvement suggestions • Identify and support automation opportunities • Accurately document time and daily records processed • Perform other duties as assigned

🎯 Requirements

• High School Diploma or equivalent • Experience using computer equipment such as laptops, monitors and routers • Intermediate level experience with MS Office products • Proficiency with Ten Key and Typing skills • Ability to read and interpret Standard Operating Procedure documents and performance / production reporting • Minimum of 1 year experience adjudicating claims and releasing for payment • Familiarity with medical claim forms CMS1500 and UB04 • Knowledge and experience with medical code sets ICD 10, HCPCS, CPT and Modifiers • Conceptual knowledge of coordination of benefits, member/provider claim appeals, and government programs (Medicare/Medicaid) • Ability to maintain confidentiality and privacy • Preferred: 3 years of experience in health care claim operations • Organizational skills and experience prioritizing project work and tasks • Experience in the health care industry working with Health Plans or Third-Party Administrators • Experience working in a remote environment • Full-time work schedule of at least 40 hours per week • Adherence to mandatory trainings, privacy and security protocols, time entry requirements, attendance and leave policies

🏖️ Benefits

• A professional development and growth-oriented workplace • Health insurance • Short-term disability • Long-term disability • 401(k) with a company match • Competitive paid time off package, including vacation, holiday, give-back day, and a floating day • Flexible environment • Authentic, innovative, and collaborative company culture