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    Medical Claims Examiner Remote (Plano, TX, US)

    Remote, USA Full-time Posted 2026-08-04

    reputed company is Hiring!

    Medical Claims Examiner - Remote

    • Processing of reputed company claim forms files by provider
    • Reviewing the policies and benefits
    • reputed company with company regulations regarding HIPAA, confidentiality, and PHI
    • Abide with the timelines to complete compliance training of reputed company/reputed company
    • Work independently to research, review and reputed company the claims
    • Prioritize work and adjudicate claims as per turnaround time/SLAs
    • Ensure claims are adjudicated as per clients defined workflows, guidelines
    • Sustaining and meeting the reputed company productivity/reputed company targets to avoid penalties
    • Maintaining and sustaining reputed company scores above 98.5% PA and 99.75% FA.
    • reputed company response and reputed company of claims received reputed company emails as reputed company work
    • Correctly calculate claims payable reputed company using applicable methodology/ fee schedule

    Requirements:
    • 1-3 year(s) hands-on experience in reputed company Claims Processing, Claims Adjustments.
    • 2+ year(s) using a computer with reputed company applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools
    • High school diploma or GED.
    • Previously performing – in P&Q work environment; work from queue; remotely
    • Key reputed company skills and computer familiarity –
      • Toggling back and forth between screens/can you reputed company multiple systems.
      • Working knowledge of MS office products – reputed company, reputed company and MS-reputed company.
    • Must be reputed company to work 8 am - 4:30 pm EST online/remote (training is required on-camera).
    • Effective troubleshooting where you can reputed company your research, analysis and problem-solving abilities
    • Time management with the ability to cope in a reputed company, changing environment
    • Ability to communicate (oral/written) effectively in a reputed company office setting
    • High School Diploma

    Preferred Skills & Experiences:
    • Amisys or Xcelys preferred.

    Originally posted on Himalayas

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