HealthEdge is seeking a Claims Examiner II to support the adjudication of healthcare claims. In this role, you will review claim data within the claims processing system to determine whether services were appropriate, benefit coverage criteria were met, and claims or line items should be paid.
This position is part of a fast-paced healthcare technology environment focused on helping health plans modernize operations. You will process assigned claims according to client guidelines, maintain productivity and quality standards, and support team initiatives and special projects.
The role is remote within the US and may involve working across multiple time zones.
Qualifications
- High school diploma required
- 1–3 years of healthcare claims processing experience
- Solid understanding of claim data analysis
- 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 collaboration skills and work ethic
Role expectations
- Process assigned claims based on client-specified guidelines
- Meet productivity, financial, and procedural accuracy standards
- Mentor junior team members
- Support projects including process documentation, training, quality audits, and surge activity
- Communicate effectively with management regarding issues and concerns
Perks and work environment
- Remote work opportunity within the US
- Full-time, permanent employment
- Opportunity to work with a healthcare technology company
- Exposure to cross-functional projects and team collaboration
- May require travel depending on company needs
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
3 weeks ago