Crawford Thomas Recruiting
Salary:
$20.00 - $26.00 per hour, depending on experience, Medical, Dental, Vision, 401K, PTO, STO
Job Summary: The
Claims Examiner
plays a critical role in ensuring accurate coding and timely processing of medical, dental, and vision claims. This full-time, in-office position is responsible for verifying claim validity, applying appropriate plan guidelines, and maintaining productivity and quality standards. The ideal candidate will demonstrate strong analytical abilities, attention to detail, and a commitment to service excellence in a moderate-noise office environment.
Job Responsibilities:
Verify claim data for completeness and accuracy using internal policy and company records. Apply a comprehensive understanding of employee medical, dental, and vision benefits during claim adjudication. Review Summary Plan Documents, adjuster reports, and precedent cases to determine coverage and liability. Accurately code and process claims within 3-5 business days of receipt. Maintain high productivity and quality standards to minimize errors and overpayments. Refer complex or questionable claims to Claims Examiner II for further investigation. Resolve escalated paid and denied claims from internal sources or the TIPS ticketing system. Collaborate with healthcare providers to collect necessary documentation for final claim determination. Complete additional tasks as assigned by management. Qualifications:
Education:
Associate's degree from a two-year college or technical school, or equivalent combination of education and experience. Experience:
Minimum 3-5 years in the employee benefits industry, processing medical claims for an insurance company or third-party administrator. Proficiency in ICD-10, CPT, and HCPCS coding systems. Strong computer skills, including Microsoft Word, Excel, and Outlook. Excellent verbal and written communication skills. Strong analytical and problem-solving skills. Dependable, punctual, and able to meet deadlines. Accurate and efficient data entry skills. Valid Class C driver's license with a clean driving record.
About the Company: Our client is a dynamic and growing insurance agency specializing in benefit and risk management services.
Job Summary: The
Claims Examiner
plays a critical role in ensuring accurate coding and timely processing of medical, dental, and vision claims. This full-time, in-office position is responsible for verifying claim validity, applying appropriate plan guidelines, and maintaining productivity and quality standards. The ideal candidate will demonstrate strong analytical abilities, attention to detail, and a commitment to service excellence in a moderate-noise office environment.
Job Responsibilities:
Verify claim data for completeness and accuracy using internal policy and company records. Apply a comprehensive understanding of employee medical, dental, and vision benefits during claim adjudication. Review Summary Plan Documents, adjuster reports, and precedent cases to determine coverage and liability. Accurately code and process claims within 3-5 business days of receipt. Maintain high productivity and quality standards to minimize errors and overpayments. Refer complex or questionable claims to Claims Examiner II for further investigation. Resolve escalated paid and denied claims from internal sources or the TIPS ticketing system. Collaborate with healthcare providers to collect necessary documentation for final claim determination. Complete additional tasks as assigned by management. Qualifications:
Education:
Associate's degree from a two-year college or technical school, or equivalent combination of education and experience. Experience:
Minimum 3-5 years in the employee benefits industry, processing medical claims for an insurance company or third-party administrator. Proficiency in ICD-10, CPT, and HCPCS coding systems. Strong computer skills, including Microsoft Word, Excel, and Outlook. Excellent verbal and written communication skills. Strong analytical and problem-solving skills. Dependable, punctual, and able to meet deadlines. Accurate and efficient data entry skills. Valid Class C driver's license with a clean driving record.
About the Company: Our client is a dynamic and growing insurance agency specializing in benefit and risk management services.