Claims Examiner
Independent Living Systems, LLC
full-time
Posted on:
Location Type: Office
Location: Miami • Florida • 🇺🇸 United States
Visit company websiteJob Level
JuniorMid-Level
About the role
- Review and analyze health insurance claims for completeness, accuracy, and compliance with policy terms and regulatory requirements
- Verify medical codes, treatment documentation, and billing information to ensure services are properly covered and billed
- Investigate and resolve claim discrepancies by communicating with providers, members, and internal departments
- Identify and escalate potential fraudulent claims or billing errors to compliance or legal teams
- Maintain detailed records of claim evaluations and stay current with healthcare laws and industry standards to support audits and improve processing workflows
Requirements
- High school diploma or GED
- Minimum of 2 years experience in claims examination, medical billing, or healthcare insurance processing
- Strong understanding of medical terminology, insurance policies, and healthcare billing codes (e.g., ICD-10, CPT)
- Proficiency with claims management software and Microsoft Office suite
- Associate’s degree or Bachelor's degree in health administration, healthcare management, or a related discipline preferred
- Certification such as Certified Professional Coder (CPC) or Certified Claims Professional (CCP) preferred
- Experience working within the health care and social assistance industry or with government healthcare programs preferred
- Familiarity with regulatory frameworks such as HIPAA and the Affordable Care Act preferred
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims examinationmedical billinghealthcare insurance processingmedical terminologyinsurance policieshealthcare billing codesICD-10CPTclaims management software
Soft skills
communicationinvestigationproblem-solvingattention to detail
Certifications
Certified Professional CoderCertified Claims Professional