Senior Claims Examiner

New

Skills

Claims disputes resolution CPT coding Health plan claims processing ICD-10 coding MCP claims processing Medicaid claims processing Medical terminology Medicare claims processing MS Office Suite PACE claims processing

The Senior Claims Examiner is responsible for examining claim records to resolve first-level disputes, issuing letters, and reviewing second-level claims, including adjustments and corrected claims. This role involves collaborating with leadership on trends in improper processing and dispute-related discrepancies while assisting the team in departmental duties to support both short- and long-term goals.

Key Responsibilities
  • Examine claim records to resolve first-level disputes and issue letters.
  • Review and process second-level claims, including adjustments and corrected claims.
  • Collaborate with leadership on trends in improper processing and dispute-related discrepancies.
  • Assist the team in departmental duties and support short- and long-term goals.
  • Establish and maintain effective relationships with team and interdepartmental staff.
  • Coordinate with leadership on identified trends and claim-related concerns.
Required Skills & Qualifications
  • 3+ years health plan claims processing.
  • 2+ years in claims disputes.
  • Experience in MCP or PACE claims processing preferred.
  • Experience with Medicare and Medicaid claims processing.
  • Strong computer skills; MS Office (Excel/Outlook/PowerPoint/Word/Teams) and related systems.
  • Ability to balance priorities, exercise discretion and resolve ambiguities.
  • Proficient in managed health care and medical terminology (CPT/HCPCS/ICD-10).
  • Understanding of Medicare/Medi-Cal pricing and DRG.
  • Knowledge of medical insurance coverage (Medical, Dental, Vision).
  • Commitment to work/life balance with 17 days of PTO, 12 holidays, and 6 sick days.

No forms. Your profile is generated instantly.

Job Type: Remote

Salary: Not Disclosed

Experience: Entry

Duration: Months

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