Claims Examiner

Vaco Atlanta is hiring a Medicare Claims Examiner to join a stable, mission-driven organization where claims expertise directly protects members and ensures payment integrity. Our client is seeking someone detail-oriented with strong CMS claims adjudication experience and a passion for accuracy, compliance, and fraud prevention.

Role: Medicare Claims Examiner
Location : Chamblee
Onsite: 100% onsite
Job Type : Permanent
Pay: $60,000 annually

What You’ll Do:

• Review and adjudicate Medicare Supplement claims for accuracy, coverage eligibility, and medical necessity
• Analyze CPT/billing codes, charges, fee schedules, medical records, and services rendered
• Approve, deny, or pend claims for additional documentation
• Investigate fraud, waste, and abuse (FWA) concerns and support payment integrity efforts
• Handle denied claims, appeals, and reprocessing
• Serve as a subject matter expert for claims/customer service teams on Medicare guidelines

What You Bring:

• 2–4+ years of Medicare Supplement claims processing experience
• Strong knowledge of CMS guidelines, claims adjudication, Medicare Benefit Policy Manual, and reimbursement practices
• Experience reviewing medical records, coding, and claims discrepancies
• High attention to detail, analytical thinking, and accuracy in a high-volume environment
• CPC/CMRS certification a plus

Why Join:

• Meaningful, high-impact work
• Collaborative team environment
• Opportunity to influence process improvements and fraud prevention initiatives
• Stable healthcare/insurance environment with career growth potential

Determining compensation for this role (and others) at Vaco/Highspring depends upon a wide array of factors including but not limited to the individual’s skill sets, experience and training, licensure and certifications, office location and other geographic considerations, as well as other business and organizational needs. With that said, as required by local law in geographies that require salary range disclosure, Vaco/Highspring notes the salary range for the role is noted in this job posting. The individual may also be eligible for discretionary bonuses, and can participate in medical, dental, and vision benefits as well as the company’s 401(k) retirement plan. Additional disclaimer: Unless otherwise noted in the job description, the position Vaco/Highspring is filing for is occupied. Please note, however, that Vaco/Highspring is regularly asked to provide talent to other organizations. By submitting to this position, you are agreeing to be included in our talent pool for future hiring for similarly qualified positions. Submissions to this position are subject to the use of AI to perform preliminary candidate screenings, focused on ensuring minimum job requirements noted in the position are satisfied. Further assessment of candidates beyond this initial phase within Vaco/Highspring will be otherwise assessed by recruiters and hiring managers. Vaco/Highspring does not have knowledge of the tools used by its clients in making final hiring decisions and cannot opine on their use of AI products.