Jobs 1 - 8 out of 8 for Medical Claims Examiner

Processing of Professional and Hospital claim forms files by provider, reviewing the policies and benefits, complying with company regulations regarding HIPAA, confidentiality, and PHI, working independently to research, review and act on the claims, prioritizing work and adjudicating claims as per ...

Support, review, and adjudicate claims in a high-volume, high-complexity caseload. Evaluate, research, and analyze claim submissions with knowledge of national claims guidelines. Process complex claim scenarios, review claims queues, serve as a resource for other Examiners, meet department metrics, ...

Support, review, and adjudicate medical claims, ensuring proper processing based on national claims guidelines. Process complex claim scenarios, serve as a resource for other Examiners, meet department metrics, and provide feedback on workflow and process improvements.

Responsible for the accurate and timely processing of self-funded medical health insurance claims. Review, analyze, and process complex claims, utilize the WLT system for adjudication, verify patient eligibility, maintain compliance with regulations, and meet established quality standards.

Responsible for processing professional and hospital claim forms, reviewing policies and benefits, ensuring compliance with HIPAA regulations, and maintaining quality scores. The candidate will work independently to research and adjudicate claims, prioritize work, and respond to claims received via ...

The Workers’ Compensation Medical Only Claims Examiner is responsible for the prompt and effective investigation of workers’ compensation claims involving injuries requiring medical treatment without lost wages. Claim adjudication requires interaction with employers, claimants, medical providers, an...

Process health plan claims, support provider inquiries, review and adjudicate medical claims for accuracy and compliance, ensure timely claims processing, handle provider inquiries, and perform data entry.

Evaluate claim eligibility, outline claim exposure, process payments to policyholders, and maintain appropriate reporting to management. Review all claim submissions for accuracy, completeness, and compliance with various Plan Documents, SPDs, and Policies. Communicate external requests for informat...