Claims Examiner II
On-siteLas Vegas, Nevada, United States
Job Summary
Review and adjudicate claims submitted for reimbursement outside auto adjudication standards daily, applying medical policies and contractual provisions to ensure precise adjustments. Generate correspondence and initiate phone inquiries to gather information from customers and providers, while collaborating with Customer Service to resolve inquiries and escalations. Execute client-requested claim adjustments for Professional and Facility claims, performing in-depth research on account receivables and spreadsheets to deliver thorough responses within established deadlines. Must be adaptable and willing to provide backup support across various departments as needed. Minimum one year of experience in medical billing or claims adjudication required.
Required Qualifications
- Strong knowledge of healthcare contracts, medical terminology, and claims processing procedures
- Prior experience processing claims
- Minimum 1 year of experience in medical billing, claims adjudication, or a related role
- Excellent written and verbal communication skills, with the ability to manage inquiries professionally and efficiently
- Strong analytical skills with the ability to research and resolve complex claim issues
- Proficiency in Microsoft Office Suite, particularly Microsoft Word and Excel
- Ability to meet production and quality standards while managing multiple priorities
- Strong problem-solving skills and the ability to maintain professionalism under pressure
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