[Remote] Claims Examiner
Note: The job is a remote job and is open to candidates in USA. Point C is a National third-party administrator (TPA) delivering customized self-funded benefit programs. They are seeking a detail-oriented Claims Examiner responsible for accurately processing medical claims while ensuring compliance with plan documents, policies, and industry regulations.
Responsibilities
- Adjudicate new claims and process adjustments, including denials upon receipt of additional information
- Review and resolve appeals and subrogation/third-party liability cases
- Manage individual inventory to ensure timely turnaround and production goals are met
- Ensure claims are processed in accordance with stop loss contract terms
- Respond to internal and external inquiries via email and other channels within established timeframes
- Follow up on missing or incomplete information to ensure claims can be accurately processed
- Maintain minimum production, financial, and procedural accuracy standards on a monthly basis
Skills
- At least 1+ year of experience in insurance claims processing
- Working knowledge of CPT and ICD-10 coding
- Basic understanding of medical terminology
- Strong communication and customer service skills
- Proficiency in Microsoft Office and general computer applications
- Ability to maintain confidentiality and comply with all company policies and procedures
- Able to work independently with minimal supervision
- Ability to prioritize, multitask, and work overtime as needed
- Associate's degree preferred
- Experience with Third Party Administrator (TPA) or self-funded claims administration preferred
Benefits
- Comprehensive medical, dental, vision, and life insurance coverage
- 401(k) retirement plan with employer match
- Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
- Paid time off (PTO) and disability leave
- Employee Assistance Program (EAP)
Company Overview