Claims Examiner-Hybrid Contract $25/hr

General Information:

Name: Claims Examiner, contract
Start: 05/05/2025 End: 09/30/2025
Pay: $25/hr.
Location: Houston, TX 77401 Onsite
Schedule: Start time between 7:00 to 8:30 a.m. Hybrid (working in office M, W, F- with every other Friday remote)


Duties:
A: Adjudicate Claims received into processing.   
Task #1: Thoroughly reviews, investigates and adjudicates claims daily, working oldest to newest claim in 30 days or less, and 98% of the time.
Task #2: Examiner should process a minimum of 14 claims per hour, or a minimum of 98 claims per day. 
Task #3:  Conduct review and investigation of pended claims and follow up with internal and external departments to finalize claims resolution within 30 days.
Task 4:  Ensure requests are processed within 30 days of receipt, with a 98% accuracy, to ensure timely resolution of claims, in adherence with regulatory requirements.
                                                                                                                                                                                                                             Responsibilty B: The claims are processed accurately as defined by standard guidelines.     
Task #1:  The claims should be adjudicated with a 98% procedural accuracy rate monthly as reviewed by weekly audit reports. 
Task #2:  The claims should be adjudicated with a 98% accuracy rate monthly as reviewed by returned claims for adjustment review.
Task #3: The claims that are manually adjudicated must have notes entered as reviewed by weekly audits, check run, returned claims, management review 98% of the time.                                                                                                                                                                                   
Task #4: Clear concise documentation/notes must be entered for each claim reviewed, which provides a historical reference of how the claim was processed at the time of adjudication.

Skills:
Knowledge of ICD-9, CPT/HCPCS coding methodologies (and their successors); claims examination functions.         
                                                                                                                                                                                           
Education:
High School Diploma or GED and 2 years claims experience.  

Salary : $25