HealthEdge offers AI-powered operational infrastructure for health insurance companies, helping them modernize operations and compete more effectively. The company is looking for a Claims Examiner II to report to the Claims Team Leader.
In this role, you will adjudicate healthcare claims using specific policies and procedures. You will review data within the claims processing system to determine whether services rendered were appropriate and whether benefit coverage criteria were met. You will also review adjudication system edits to determine whether to pay the claim and/or line item(s).
Responsibilities include processing assigned claims based on client-specified guidelines or direction from the team leader, meeting productivity targets and accuracy standards, mentoring junior team members, and collaborating on special projects such as process documentation, training, quality audits, surge support, and other client-related initiatives.
The role may also involve work across provider data, authorizations, enrollment, and related activities. The position is remote within the U.S. and may require collaboration across multiple time zones.
Qualifications
- High school diploma required
- 1 to 3 years of healthcare claims processing experience
- Strong ability to analyze claim data
- Knowledge of ICD-10, CPT, and HCPCS coding preferred
- Familiarity with physician practices, hospital coding, billing, medical terminology, UB-04, CMS-1500, and authorizations
- Ability to learn new skills quickly
- Strong team collaboration and work ethic
- Ability to adapt quickly in a fast-paced environment
- Self-starter with a willingness to learn
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
3 weeks ago