Claims Examiner III

Job Summary

A company is looking for a Claims Examiner III to support and adjudicate claims while enhancing team performance.

Key Responsibilities

• Review and adjudicate complex claims in accordance with established policies and guidelines
• Provide coaching and training to team members, fostering a collaborative environment
• Conduct audits and process reviews to identify opportunities for improvement in departmental outcomes

Required Qualifications

• High School Diploma
• 6+ years of experience in processing or analyzing medical claims, preferably in a TPA environment
• Strong knowledge of CPT/HCPC and ICD-10 coding rules
• Basic proficiency in Windows-based applications and functional comfort with virtual meeting platforms
• General knowledge of CMS claims submission regulations