Medical Claims Examiner II

📋 Description

• Review, investigate, and verify coverage to ensure proper processing of medical claims
• Process complex claim scenarios per SPDs (COB, Prior Authorization, HRA, Transplant, High Dollar)
• Review queues and address nuances with appropriate parties
• Be a go-to resource for Examiners; assist with training and special projects
• Support leadership with inventory, process development, and auditing

🎯 Requirements

• High School Diploma
• 4+ years processing/adjusting/analyzing medical claims (TPA environment preferred)
• Strong CPT/HCPCS and ICD-10 knowledge
• Prioritize, manage time, and work independently
• Comfort with Zoom, Microsoft Teams, or Google Meet
• CMS claims submission regulations knowledge

🎁 Benefits

• Comprehensive benefits package
• Flexible PTO; up to 16 weeks paid parental leave
• Paid holidays; 401k program
• Transportation perks; education reimbursement
• 2 days paid paw-ternity leave