Medical Claims Examiner

Working remotely, the Medical Claims Examiner will process professional claim forms, review policies and benefits, and ensure compliance with HIPAA regulations while maintaining high-quality scores and meeting client productivity targets. Key responsibilities Process and adjudicate claims according to defined workflows and guidelines Research, review, and act on claims while ensuring timely responses and resolutions Maintain quality scores above 98.5% for PA and 99.75% for FA, adhering to productivity targets Required qualifications 1-3 years of hands-on experience in healthcare claims processing and claims adjustments High school diploma or GED 2+ years of experience using Windows applications and navigating multiple computer systems Familiarity with MS Office products, including Outlook, Word, and Excel Ability to work 8 am - 4:30 pm EST online/remote, with required on-camera training