Claims Examiner
Vaco by Highspring · Brookhaven, GA · 1 mo ago
On-siteCustomer ServiceFull-time
About the role
This role is ideal for a detail-oriented professional with experience in claims processing, claims adjudication, and regulatory compliance.
Responsibilities
- Review and process claims
- Ensure accurate benefit determinations
- Identify billing discrepancies
- Support payment integrity initiatives
- Partner with internal teams to resolve claim issues
- Support appeals
- Contribute to process improvements
Requirements
- Bachelor's degree in Business, Healthcare Administration, or a related field preferred; equivalent work experience considered
- 2+ years of claims processing or claims examination experience
- Experience reviewing, analyzing, and adjudicating claims in accordance with plan benefits, policies, and applicable guidelines
- Knowledge of claims processing, billing, reimbursement practices, and electronic claims transactions
- Experience identifying billing discrepancies, payment errors, and potential fraud, waste, and abuse
- Ability to investigate claim issues, determine appropriate claim outcomes, and resolve discrepancies efficiently
- Experience handling claim appeals, adjustments, and reprocessing activities
- Strong understanding of regulatory and compliance requirements
- Proficiency with claims processing systems and Microsoft Office Suite
- Excellent analytical, organizational, and problem-solving skills with exceptional attention to detail
- Strong verbal and written communication skills with the ability to collaborate across cross-functional teams
- Able to manage multiple priorities and work effectively in a fast-paced, high-volume environment
- Professional coding, claims, or reimbursement certifications are a plus
Qualifications
Not specified
Skills
Not specified
Benefits
Medical, dental, and vision benefits as well as the company’s 401(k) retirement plan are available.
Pay
USD55000 - USD65000 per year
Schedule
Not specified