Claims Examiner III

The Claims Examiner III is a senior-level claims professional responsible for the accurate and timely adjudication of complex professional and institutional claims in accordance with regulatory requirements, contractual agreements, and internal policies.

Requirements

• High School Diploma or GED
• Minimum of 3+ years of experience as a Medical Claims Examiner
• Experience processing Medicare Advantage and/or managed care claims preferred
• Strong experience with contract interpretation and benefit application
• Working knowledge of CMS guidelines, Medicare regulations, and healthcare claims processing standards
• Strong analytical and problem-solving skills
• Proficiency in Windows-based systems and claims processing applications