Claims Examiner Sr

Job Description

Job Description

Claims Examiner (Medical Claims) – Irving, TX (3-Month Contract)

Job Title: Claims Examiner (Senior Medical Claims)
Location: Irving, TX
Job Type: 3-Month Contract
Schedule: Full-Time | 5 Days/Week | 8-Hour Shifts
Company: Sigma Inc.

Join Our Team as a Claims Examiner!

Sigma Inc. is seeking an experienced Claims Examiner to join our healthcare team in Irving, TX . This is an excellent opportunity for professionals with experience processing medical claims, Medicare, managed care, and healthcare reimbursement . If you have strong analytical skills, attention to detail, and a solid understanding of medical claims processing, we'd like to hear from you!

Key Responsibilities

• Review, analyze, research, and resolve complex medical claims.
• Process medical claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms.
• Review claims from hospitals, physicians, home health agencies, laboratories, and DME providers.
• Process provider refunds, member reimbursements, claim adjustments, and overpayment recoveries.
• Research and resolve claim discrepancies while ensuring compliance with federal regulations.
• Analyze claims processing trends and recommend workflow improvements.
• Participate in system testing, upgrades, and implementation of new claims processes.
• Assist with training and mentoring new Claims Examiners.
• Communicate professionally with providers, members, and internal departments.
• Collaborate with Business Configuration, Appeals, Provider Data, Network Management, and other operational teams.
• Maintain compliance with HIPAA and organizational policies.
• Meet established productivity and quality standards.

Required Qualifications

• Associate's degree or equivalent work experience.
• Minimum 3 years of medical claims processing experience .
• Experience processing healthcare claims within the insurance or managed care industry.
• Strong knowledge of:
  • Medical Terminology
  • CPT Codes
  • HCPCS
  • ICD-10 Coding
  • Revenue Codes
  • CMS-1500
  • CMS-1450 / UB-04 Claim Forms
  • Medical Reimbursement Methodologies
• Excellent analytical, organizational, and problem-solving skills.
• Strong written and verbal communication skills.
• Proficiency with:
  • Microsoft Excel
  • Microsoft Word
  • Outlook
  • PowerPoint
  • Microsoft Office Suite

Preferred Qualifications

• Experience with:
  • Medicare
  • Medicare Advantage
  • Managed Care
  • Health Exchange Plans
  • TRICARE
• Experience with provider refunds, appeals, claim adjustments, and reimbursement processing.
• Previous experience assisting with system testing, process improvements, or associate training.