[Remote] Claims Examiner

Note: The job is a remote job and is open to candidates in USA. Point C is a National third-party administrator (TPA) delivering customized self-funded benefit programs. They are seeking a detail-oriented Claims Examiner responsible for accurately processing medical claims while ensuring compliance with plan documents, policies, and industry regulations.

Responsibilities

• Adjudicate new claims and process adjustments, including denials upon receipt of additional information
• Review and resolve appeals and subrogation/third-party liability cases
• Manage individual inventory to ensure timely turnaround and production goals are met
• Ensure claims are processed in accordance with stop loss contract terms
• Respond to internal and external inquiries via email and other channels within established timeframes
• Follow up on missing or incomplete information to ensure claims can be accurately processed
• Maintain minimum production, financial, and procedural accuracy standards on a monthly basis

Skills

• At least 1+ year of experience in insurance claims processing
• Working knowledge of CPT and ICD-10 coding
• Basic understanding of medical terminology
• Strong communication and customer service skills
• Proficiency in Microsoft Office and general computer applications
• Ability to maintain confidentiality and comply with all company policies and procedures
• Able to work independently with minimal supervision
• Ability to prioritize, multitask, and work overtime as needed
• Associate's degree preferred
• Experience with Third Party Administrator (TPA) or self-funded claims administration preferred

Benefits

• Comprehensive medical, dental, vision, and life insurance coverage
• 401(k) retirement plan with employer match
• Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
• Paid time off (PTO) and disability leave
• Employee Assistance Program (EAP)

Company Overview