Claims Examiner

Responsibilities:

• Review and process health care claims promptly and accurately
• Verify claim details using CPT and ICD codes
• Address inquiries from providers, members, and insurers regarding claim status
• Ensure compliance with internal policies and regulatory requirements
• Maintain detailed and accurate documentation of claim processing
• Collaborate with team members to resolve any discrepancies

Qualifications:

• Proven experience in processing health care claims
• Knowledge of CPT, ICD codes, and medical billing procedures
• Insurance certifications are an asset
• Spanish language is MUST
• Strong analytical and problem-solving skills
• Excellent member services and phone skills
• Excellent communication and organizational abilities