Medical Claims Examiner

Job Description

Hybrid/ Full Time (Must be able to go onsite for training the first two weeks)

A national healthcare consulting and claims administration organization is adding a Medical Claims Examiner due to continued growth and increased client volume.

On a daily basis, you will review professional and facility medical claims for accuracy, medical necessity, and policy alignment. You'll interpret clinical documentation and coding to determine appropriate payment outcomes, identify discrepancies or potential overbilling, and communicate decisions to providers and internal partners.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to View email address on click.appcast.io learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy:

Skills and Requirements

2+ years of hands-on medical claims examination or healthcare billing experience

Strong working knowledge of ICD-10, CPT, and HCPCS coding

Experience reviewing medical records and determining medical necessity

Familiarity with payer policies, benefit plans, and reimbursement methodologies

Ability to clearly document and communicate claim decisions

Comfortable working in claims systems and Microsoft Office CPC, CPMA, CCS, or similar certification

Experience with claim audits, appeals, or complex claim reviews

Exposure to CMS guidelines or regulatory-driven claims environments

Prior work in a consulting, TPA, or managed care setting