Claims Examiner, Healthcare Insurance Services

Job Description

Job Description

Overview

Opportunities for you!

• Consecutively recognized as a top employer by Forbes, and in 2025 by Newsweek

• Free Continuing Education and certification

• Tuition reimbursement, education programs and scholarships

• Vacation time starts building on Day 1, and builds with your seniority

• Free money toward retirement with a 403(b) and matching contributions

• Great food options with on-demand ordering

• Free parking and electric charging

Commitment to diversity and inclusion is a cornerstone of our culture at Community. All are welcome as valued members of our community.

We know that our ability to provide the highest level of care is through taking care of our incredible teams. Learn more on our Benefits page.

Responsibilities

The Claims Examiner is responsible for accurately processing professional and hospital claims for Community Care Health (CCH) for in-network and out-of-network providers. This role will review and analyze claims: verifying coverage, assessing eligibility, and determining the validity of claims based on policy terms.

Qualifications

Education

• High School Diploma, High School Equivalency (HSE) or Completion of a CHS Approved Individualized Education Plan (IEP) Certificate required
• Associate's Degree preferred

Experience

• 1 year of medical claims processing/adjudication experience
• Experience working with claims system/applications and troubleshooting preferred
• Trizetto/QNXT software experience preferred
• Experience using Blue Shield or Anthem portals (e.g., verifying member eligibility, checking claim statuses, or tracking payments).

• Medical Coding/Billing knowledge

• Medical Terminology knowledge