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

Claims Examiner (Medical Claims)

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.