Claims Examiner

Claims Examiner

The Claims Examiner is detail-oriented and will be responsible for reviewing and adjudicating health insurance claims for all products and all lines of business, including but limited to Medicare, Self-Funded, Fully Insured, ensuring accuracy compliance with policies and regulations and timely settlements. This role involves assessing claims, verifying information, and communicating effectively with internal stakeholders, members, providers and their office staff and other insurance companies.

Qualifications and Requirements:

• High school diploma or equivalent required.
• Associate degree in healthcare administration, Business Administration, or related field preferred.
• Two years' experience as a Health Insurance Claims Examiner or similar role in the insurance industry preferred.
• In-depth knowledge of medical terminology, coding systems (ICD-10, CPT, HCPCS), and healthcare billing procedures.
• Familiarity with health insurance policies, regulations, and compliance standards.
• Strong analytical skills with attention to detail and accuracy in claims processing.
• Excellent communication and interpersonal abilities to interact effectively with customers and stakeholders.
• Proficiency in using computer systems, including claims processing software and Microsoft Office Suite.
• Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
• Certification in Health Insurance Portability and Accountability Act (HIPAA) compliance is a plus.
• Strong commitment to confidentiality and ethical conduct in handling sensitive healthcare data.

EEO Statement: All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.