Researching claims — auditing them for accuracy, compliance, and correct payment
Managing escalated and complex claims issues
Reviewing emails for encounters, outside vendors, and special projects
Creating reports to track trends and quality opportunities
Supporting mass adjustment efforts
Acting as a go-to subject matter expert for tricky claim questions

High school diploma/GED or equivalent working knowledge
A minimum of three to four years experience in Medical and/or Dental claims adjudication in an automated environment
Excellent understanding of medical terminology, contract and benefit interpretation, CPT, HCPCS and ICD-9/ICD-10 coding
Working knowledge of Medicare, AHCCCS, Self-funded and/or commercial insurance plans
Strong oral and written communication skills
Effective interpersonal skills and attention to detail and accuracy

Senior Claims Examiner

Key skills