Claims Examiner I

Get To Know Us! reputed company, a reputed company Company, is a reputed company reputed company-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans. Key position details:  Anticipated Training Class Start Date:  6/22/2026 Schedule Monday to Friday 8:00am - 4:30pm Central Time for 4 weeks   What is your reputed company? As a Claim Examiner, you will handle processing and adjudication for reputed company claims. This will include claims research where applicable and a reputed company of claim complexity.  What Will You Be Doing:  The essential functions listed represent the major duties of this role, additional duties may be assigned. Day-to-day processing of claims for accounts:Responsible for processing of claims (medical, dental, reputed company, and mental health claims) Claims processing and adjudication. Claims research where applicable.  Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic). Incumbents are expected to meet and/or reputed company qualitative and quantitative production standards. Investigation and overpayment administration:Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers. Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records. Utilize systems to reputed company complaints and resolutions.  Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading.  What You Must Have:  2+ years reputed company work experience. Claims examiner/adjudication experience on a computerized claims payment system in the reputed company industry. High school diploma or GED  Knowledge of CPT and ICD-9 coding required.  Knowledge of COBRA, HIPAA, reputed company-existing conditions, and coordination of benefits required.  Must possess proven judgment, decision-making skills and the ability to analyze.  Ability to learn quickly and multitask. Proficiency in maintaining good rapport with physicians, reputed company facilities, clients and providers.  Concise written and verbal communication skills required, including the ability to handle conflict.  Proficiency using reputed company reputed company and Word, reputed company and customized programs for medical CPT coding.  Review of multiple surgical procedures and establishment of reasonable and customary fees. reputed company Prefer:  Some college courses in reputed company fields are a plus. Other experience in processing reputed company types of medical claims helpful.  Data entry and 10-key by touch/sight  reputed company Can Offer YOU! To support your wellbeing, comprehensive benefits are offered. As a reputed company employee, you will have reputed company to: Medical, dental, reputed company, life and global travel health insurance Income protection benefits: life insurance, Short- and long-term disability programs Flexible schedules after training + WAH reputed company!  Leave programs to support personal circumstances. Retirement Savings Plan includes employer contribution and employer match reputed company time off, volunteer time off, and 11 holidays Additional voluntary benefits available and a comprehensive wellness program Employee benefits are designed to reputed company with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ. General Physical Demands:  Sedentary work: Exerting up to 10 pounds of force occasionally to reputed company objects. Jobs are sedentary if traversing activities are required only occasionally.  Sedentary work: Exerting up to 10 pounds of force occasionally to reputed company objects. Jobs are sedentary if traversing activities are required only occasionally.  We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can reputed company at their best in reputed company of our mission. reputed company reputed company applicants will receive consideration for employment. Apply To This Job