Job Description

Claims Examiner

The Claims Examiner (Associate) is responsible for reviewing and processing claims in accordance with established guidelines and procedures. This role requires a keen eye for detail and a strong understanding of the Common Procedure Coding System (CPCS). The ideal candidate will work remotely, collaborating with team members to ensure accurate and timely claims processing while maintaining high standards of quality and compliance.

Responsibilities:

• Review and analyze claims submissions to determine eligibility and compliance with company policies and procedures.
• Utilize the Common Procedure Coding System (CPCS) to accurately code and process claims.
• Communicate with healthcare providers and clients to gather necessary information and resolve discrepancies.
• Maintain detailed records of claims processing activities and decisions.
• Identify and escalate complex claims issues to senior examiners or management as needed.
• Stay updated on industry regulations and changes in coding practices to ensure compliance.
• Participate in training and development programs to enhance skills and knowledge in claims processing.
• Contribute to process improvement initiatives to enhance efficiency and accuracy in claims processing.

Mandatory Skills:

• Proficient in the Common Procedure Coding System (CPCS).
• Strong analytical skills with attention to detail.
• Excellent communication skills, both verbal and written.
• Ability to work independently and manage time effectively in a remote environment.
• Proficient in using claims processing software and Microsoft Office Suite.

Preferred Skills:

• Experience in the healthcare or insurance industry.
• Knowledge of medical terminology and healthcare regulations.
• Familiarity with electronic health records (EHR) systems.
• Previous experience in a claims processing role.

Qualifications:

• Bachelor's degree in a relevant field or equivalent work experience.
• Certification in medical coding or claims processing is a plus.
• Minimum of 1-2 years of experience in claims examination or a related field.

If you are a detail-oriented professional with a strong background in claims processing and a passion for accuracy, we encourage you to apply for the Claims Examiner (Associate) position. Join our team and contribute to delivering exceptional service in the BPO/KPO industry.

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