Claims Examiner - Healthcare Claims Processing

Claims Examiner – Healthcare Claims Processing (UB-04 & CMS-1500)

Sigma Inc. is seeking a detail-oriented Claims Examiner to join our healthcare operations team in Irving, TX. This is an excellent opportunity for professionals with experience in healthcare claims processing, medical claims adjudication, data entry, and HIPAA-compliant environments.

The ideal candidate will have experience reviewing and processing UB-04 and CMS-1500 claims, resolving claim issues, maintaining high accuracy standards, and working collaboratively with healthcare providers and internal departments.

Key Responsibilities

• Process and adjudicate healthcare claims, including UB-04 and CMS-1500 claims forms
• Maintain production standards of approximately 150 claims per day
• Achieve and maintain 98% statistical accuracy and 98% financial accuracy
• Perform claim review, data entry, validation, and issue resolution
• Research and correct DoD error reports as needed
• Respond to provider, customer service, and claims-related inquiries in a timely manner
• Collaborate with Business Configuration, Network Management, Provider Data, Appeals, Grievances, and other operational teams
• Ensure compliance with healthcare regulations, policies, and HIPAA requirements
• Support quality assurance initiatives and continuous process improvements
• Perform additional duties as assigned by management

Required Qualifications

• High School Diploma or equivalent
• Experience processing healthcare claims preferred
• Knowledge of UB-04 and CMS-1500 claim forms
• Strong data entry and analytical skills
• Ability to maintain productivity and accuracy standards
• Excellent attention to detail and organizational skills
• Strong written and verbal communication skills
• Ability to work independently and in a team-oriented environment
• Understanding of HIPAA regulations and Protected Health Information (PHI) requirements

Preferred Skills

• Medical Claims Processing
• Claims Adjudication
• Healthcare Administration
• Insurance Claims Review
• Provider Relations
• Data Entry
• Claims Resolution
• Quality Assurance
• HIPAA Compliance
• Medical Billing
• Healthcare Operations