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Medical Claims Examiner

Salary undisclosed

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  • TITLE: Medical Health Plan Claim Examiner
  • START DATE: ASAP
  • TERM: Contract to Hire
  • LOCATION: FULLY REMOTE
  • HOURS: Mon-Fri 8:00 5:00
  • HOURLY RATE: $21.63-$28.85/hour (depending on experience)
  • REFERRAL BONUS: $500

SUMMARY:

A medical health plan claim examiner reviews and analyzes medical insurance claims submitted by healthcare providers, verifying the accuracy of billing codes, medical necessity of procedures, and patient eligibility to determine if the claim should be approved or denied, all while adhering to company policies and regulatory guidelines; essentially ensuring the insurance company pays only for legitimate and covered medical services.

Required skills and qualifications:

• 1+ years' experience in basic medical terminology, diagnoses, and procedures to evaluate the clinical appropriateness of claims.

• Thorough knowledge of health insurance plans, coverage details, and benefit structures.

• Familiarity with industry standards and regulatory requirements related to medical claims processing.