Health Insurance Claims Examiner - (Hybrid, Pittsburgh, PA 15233)

Job Description

Job Description

Health Insurance Claims Examiner  - (Hybrid, Pittsburgh, PA 15233)

• Job Type: Full-Time, Direct-Hire (Permanent placement on company payroll with full benefits; not a temporary job)
• Location: Pittsburgh, PA 15233
• Schedule: Full-Time, Day Shift (Hybrid schedule with primary remote work and occasional on-site office days in Pittsburgh based on business needs; overtime as required)
• New Hire Starting Base Pay: $19.80 – $22.45 per hour (Starting salary placement is determined by direct claims adjudication, medical coding, or health plan operations experience.)
• Future Earning Potential: Position salary range progresses up to $30.40 per hour over time through performance, tenure, and administrative career ladder advancement.

Mandatory Qualifications

• Education: High school diploma or GED equivalent required.
• Experience & Skills: Minimum of one (1) year of health insurance claims processing experience required. Working knowledge of Coordination of Benefits (COB), commercial insurance, Medicaid, and Medicare products required.
• Systems Knowledge: Required proficiency in medical terminology, knowledge of ICD coding, CPT coding, and QWERTY keyboarding. Competency in Microsoft Office Suite and general PC applications required.
• Communication: Strong organizational, interpersonal, and written/verbal communication skills to collaborate effectively across departments and maintain client satisfaction.

How You'll Make an Impact

• Claims Adjudication & Processing: Process standard to moderately complex healthcare claims, including Coordination of Benefits (COB), in accordance with established policies while meeting or exceeding production and quality metrics.
• Exception & Error Resolution: Process OASNet/Batch Edit errors and resolve outstanding claims holds in a timely manner following designated operational standards.
• Operational Support & Prioritization: Maintain mail date integrity, assist adjacent operational teams during backlog periods, and manage assigned daily tasks efficiently.
• Continuous Improvement & Compliance: Participate in training programs, contribute to quality improvement initiatives during team meetings, and strictly maintain employee and insured confidentiality.

What We Offer

• Education & Career Growth: Tuition assistance programs, professional development resources, and structured administrative career ladder advancement.
• Health & Well-Being: Comprehensive medical, dental, and vision coverage options, plus wellness support.
• Dual-Tier Retirement Program: Generous combined retirement package with employer matching funds and company-paid retirement contributions up to 8% based on your plan elections.
• Work-Life Balance & Time Off: Paid holidays, generous annual paid time off (PTO), paid parental leave, and flexible hybrid remote work options.