Claims Examiner
Relation Insurance Services
full-time
Posted on:
Location Type: Remote
Location: Oklahoma • United States
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Salary
💰 $15 - $32 per hour
Job Level
About the role
- Reviews and validates claims for accuracy, completeness, and eligibility based on policy terms and guidelines
- Analyzes, adjudicates, and resolves claims by approving or denying documentation, calculating benefit amounts, and initiating payments or composing denial letters
- Ensures legal compliance with company policies, procedures, and applicable state and federal regulations throughout the claims process
- Maintains accurate records of claims, settlements, denials, and related documentation
- Addresses questions and concerns from providers, clients, and internal personnel regarding the adjudication process
- Reports overpayments, underpayments, and irregularities to supervisors
- Communicates with reinsurance brokers and other stakeholders to obtain necessary information for claim processing
- Verifies member eligibility, benefit coverage, and authorizations as needed
- Protects confidential information and ensure HIPAA compliance
- Participates in process improvement initiatives and updates documentation as required
- Special projects and other duties as assigned
Requirements
- High school diploma or equivalent required
- Intermediate computer skills, including email, database activity, word processing, and spreadsheets
- Ability to handle multiple tasks simultaneously and adapt to changing priorities
- Strong analytical, problem-solving, and communication skills
- Associate’s degree or technical college coursework preferred
- 1–3 years of healthcare reimbursement, claims processing, or customer service experience preferred
- In-depth knowledge of medical coding principles is helpful
- Familiarity with Medicaid, Medicare, and commercial insurance claims preferred
- Experience in provider contract development, medical billing/coding, patient accounting, claims auditing, or revenue cycle improvement
Benefits
- Competitive pay
- A safe and healthy work environment provided by our robust benefit program including family health and wellness programs
- 401K
- employee assistance programs
- paid time off
- paid holidays
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims processingmedical codingbenefit calculationdocumentation analysisclaims adjudicationrevenue cycle improvementclaims auditingprovider contract developmentpatient accountingHIPAA compliance
Soft Skills
analytical skillsproblem-solving skillscommunication skillsadaptabilitymultitaskingattention to detailcustomer serviceprocess improvementconfidentialityinterpersonal skills