Claims Examiner

Imagenet LLC

Claims Examiner adjudicating medical claims and provider disputes for Imagenet, a healthcare back-office services company. Reviewing eligibility, documentation, coding, reimbursement, appeals, and complex claims remotely.

Posted 8/4/2026full-timeRemote • Florida • 🇺🇸 United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical claims processing and adjudication, with a strong understanding of ICD-9 and ICD-10 coding. Proficient in provider dispute resolution and maintaining accurate records while ensuring compliance with reimbursement methodologies.

Highest-signal resume keywords

Medical Claims ProcessingProvider Dispute ResolutionICD-9 and ICD-10 UnderstandingAttention to DetailWritten and Verbal Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationData EntryMathematical ComputationEligibility VerificationClaims ProcessingMedical TerminologyClaims ReviewReimbursement MethodologiesProvider CredentialingClaims Adjustments

Soft Skills

Time ManagementDecision-MakingTeam CollaborationIndependent WorkCommunication

Tools & Technologies

MS Office

Industry Keywords

Healthcare ClaimsClaims Processing EnvironmentProvider Dispute RequestsAppealsReconsiderations

About the role

Key responsibilities & impact

Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies
Review and investigate provider dispute requests, appeals, and reconsiderations related to processed medical claims
Verify patient eligibility, provider credentialing, and coverage details
Communicate with internal resources and stakeholders to resolve claim discrepancies, request additional information, or clarify issues
Maintain accurate and detailed records of claims processing activities
Review claim forms and supporting documents
Determine eligibility and verify data accuracy
Request additional information when needed
Process claims end-to-end
Identify and escalate complex or unusual claims for further review or investigation
Handle more complex claims with multiple services and providers
Participate in ongoing training and professional development activities

Requirements

What you’ll need

At least 1–2 years of experience working closely with healthcare claims or in a claims processing/adjudication environment
Experience processing Provider Dispute Resolution (PDR), appeals, reconsiderations, or claim adjustments is highly preferred
Understanding of health claims processing/adjudication
Ability to perform basic to intermediate mathematical computation routines
Medical terminology strongly preferred
Understanding of ICD-9 and ICD-10
Basic MS Office computer skills
Ability to work independently or within a team
Time management skills
Written and verbal communication skills
Attention to detail
Sound decision-making skills

Benefits

Comp & perks

Remote work offered
Equipment provided
Paid training to set you up for success
Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
Paid Time Off (PTO)
7 paid holidays
A supportive team and a company that values internal growth