Institutional Claims Examiner I

About the role

We’re looking for a detail oriented Institutional Claims Examiner to join our team and ensure the accurate and compliant processing of institutional healthcare claims across all lines of business.

Responsibilities

• Adjudicate claims
• Verify medical and billing accuracy
• Ensure compliance with CMS, DMHC, DHS, and network policies
• Demonstrate strong analytical skills
• Proficiency in CPT, ICD-10, Revenue, Bill Type, and HCPCS coding
• Maintain data integrity and timely payment resolution
• Support provider relations
• Prevent discrepancies
• Uphold the highest standards of accuracy and compliance in claims processing

Requirements

The ideal candidate will demonstrate strong analytical skills, proficiency in CPT, ICD-10, Revenue, Bill Type, and HCPCS coding, and a commitment to maintaining data integrity and timely payment resolution.

Qualifications

This position plays a key role in supporting provider relations, preventing discrepancies, and upholding the highest standards of accuracy and compliance in claims processing.