Medical Claims Examiner Senior – Onsite
Location: Irving, TX 75039
Assignment Details:
- Duration: 12 Weeks
- Schedule: Monday – Friday | 8:00 AM – 5:00 PM
- Guaranteed Hours: 40/week
- Pay Rate: $20 – $24/hr (W2)
Job Summary
We are seeking an experienced Claims Examiner Senior. The ideal candidate will have extensive experience processing complex medical claims, ensuring compliance with federal regulations, and resolving claim payment issues accurately and efficiently.
Minimum Requirements
- High School Diploma (proof of education required).
- Minimum 3 years of medical claims processing experience in the healthcare industry.
- Experience processing CMS-1500 and UB-04/CMS-1450 claims.
- Knowledge of medical claims adjudication, reimbursement, and federal regulations.
- Strong analytical, problem-solving, and communication skills.
Key Responsibilities
- Review, analyze, research, and resolve complex medical claims.
- Process medical claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms.
- Ensure claims are processed according to policies, procedures, and federal regulations.
- Investigate and resolve claim overpayments, underpayments, and reimbursement issues.
- Process provider refunds, claim reconsiderations, and member reimbursements.
- Complete claim adjustments, recover overpayments, and perform batch claim adjudication.
- Collaborate with Business Configuration, Network Management, Provider Data, Appeals, and other operational teams.
- Assist with system testing, database improvements, and process implementations.
- Escalate complex claim issues to leadership when necessary.
- Serve as a resource for claims processing support and quality assurance.
#MED1
Pay: $20.00 - $24.00 per hour
Application Question(s):
- Do you have a High School Diploma? Can you provide proof of education?
- Have you processed CMS-1500 (professional) and UB-04/CMS-1450 (facility) medical claims?
- Do you have experience with medical claims adjudication, including claim adjustments, overpayments, and underpayments?
- Are you familiar with federal regulations related to medical claims processing?
- Have you worked with provider refunds, reconsiderations, or member reimbursements?
- Email address:
- Availability time for call:
Experience:
- Medical Claims Examiner in in the healthcare industry: 4 years (Required)
Work Location: In person
