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.

Vaco by Highspring values a diverse workplace and strongly encourages women, people of color, LGBTQ+ individuals, people with disabilities, members of ethnic minorities, foreign-born residents, and veterans to apply.

EEO Notice

Vaco by Highspring is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race (including but not limited to traits historically associated with race such as hair texture and hair style), color, sex (includes pregnancy or related conditions), religion or creed, national origin, citizenship, age, disability, status as a veteran, union membership, ethnicity, gender, gender identity, gender expression, sexual orientation, marital status, political affiliation, or any other protected characteristics as required by federal, state or local law.

Vaco by Highspring and its parents, affiliates, and subsidiaries are committed to the full inclusion of all qualified individuals. As part of this commitment, Vaco by Highspring and its parents, affiliates, and subsidiaries will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact View email address on click.appcast.io .

Vaco by Highspring also wants all applicants to know their rights that workplace discrimination is illegal.

By submitting to this position, you agree that you will be giving Vaco by Highspring the exclusive right to present your as a candidate for the foregoing employment opportunity. You further agree that you have represented information about yourself accurately and have not affirmatively misrepresented your qualifications. You also agree to maintain as confidential, to the fullest extent permitted by law, any information you learn from Vaco by Highspring about the position and you will limit disclosure of information about the position only to the extent necessary to perform any obligations in furtherance of your application. In exchange, Vaco by Highspring agrees to exercise reasonable efforts to represent you through all solicitation, job screening and resume dispersal.

Privacy Notice

Vaco by Highspring and its parents, affiliates, and subsidiaries ("we," "our," or "Vaco by Highspring") respects your privacy and are committed to providing transparent notice of our policies.

• California residents may access Vaco by Highspring HR Notice at Collection for California Applicants and Employees here.
• Virginia residents may access our state specific policies here.
• Residents of all other states may access our policies here.
• Canadian residents may access our policies in English here and in French here.
• Residents of countries governed by GDPR may access our policies here.

Pay Transparency Notice

Determining compensation for this role (and others) at Vaco by Highspring depends upon a wide array of factors including but not limited to:

• the individual's skill sets, experience and training;
• licensure and certification requirements;
• office location and other geographic considerations;
• other business and organizational needs.

With that said, as required by local law, Vaco by Highspring believes that the following salary range referenced above reasonably estimates the base compensation for an individual hired into this position in geographies that require salary range disclosure. The individual may also be eligible for discretionary bonuses.