Claims Examiner

Intermountain Healthcare; Las Vegas (NV); Remote; USD 10,000 - 60,000; Full time

Job summary

An established industry player seeks a Claims Examiner I to join their remote team in Las Vegas. This role involves processing medical claims and providing exceptional customer service to health plans and providers. The ideal candidate will have experience in claims processing and a strong attention to detail. You'll be part of a dynamic team focused on quality improvement and operational excellence, ensuring that all claims are handled efficiently and accurately. If you thrive in a fast-paced environment and are passionate about healthcare, this opportunity is perfect for you.

Benefits

Comprehensive Benefits Package

Wellness Programs

Work-Life Balance Initiatives

Qualifications

• One year of claims processing or customer service experience required.
• Must demonstrate accuracy and efficiency in processing claims.

Responsibilities

• Adjudicate physician claims accurately and in a timely manner.
• Support quality improvement initiatives and maintain compliance standards.

Skills

Claims Processing

Customer Service

Attention to Detail

Typing Speed (30 WPM)

Communication Skills

Education

Associates Degree or Some College Coursework

Job description

Job Description:

The Claims Examiner I is responsible for inbound calls from providers and health plans and adjudicates physician claims in a timely and accurate manner.

Schedule:

5 days, 0700-1530 - This is a remote position.

The Claims Examiner I provides superior customer service consistent with company standards and goals, including handling inbound calls from providers and health plans. They are responsible for quality and continuous improvement within their scope of work and must adhere to all actions and responsibilities outlined in company-controlled documentation. The role also involves supporting the organization’s quality improvement initiatives.

The position involves processing medical claims (CPT, ICD, and Revenue Coding) according to production standards, including timely follow-up on inquiries and accurate logging of all calls and emails. Maintaining minimum accuracy standards, following up promptly to meet compliance standards for claims, pends, and tasks, and reviewing claim images and batches for accuracy are essential duties.

The Claims Examiner I uses proper plan documentation to determine benefits and accurately adjudicate claims. They are expected to meet and maintain minimum production levels and complete reports and projects assigned by the supervisor. Active participation in meetings, training, and committees, along with reviewing feedback from supervisors, trainers, auditors, and trending spreadsheets, is also required. The role involves identifying areas for improvement and implementing necessary steps.

Minimum Qualifications:

• One year of claims processing, claims logging, or customer service experience in a managed care environment.
• Demonstrated minimum of 100 SPM on ten key and 30 WPM typing.

Preferred Qualifications:

• Associates degree or some college coursework from an accredited institution (education verified).
• Excellent verbal, written, and interpersonal communication skills.
• Consistent accuracy and processing efficiency.
• Ability to resolve complex claims issues with attention to detail.

Physical Requirements:

Manual dexterity, hearing, seeing, speaking.

Location:

Central Office - Las Vegas

Work City:

Las Vegas

Work State:

Nevada

Scheduled Weekly Hours:

40

The hourly rate ranges from $18.38 to $26.65, depending on experience.

We offer a comprehensive benefits package promoting wellness and work-life balance. Learn more here.

Intermountain Health is an equal opportunity employer. Qualified applicants will be considered without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

We use HiredScore, an AI platform, to enhance the application process. All final hiring decisions are made by Intermountain Health personnel to ensure fairness. Your privacy is protected, and your data is used solely for recruitment purposes.

All positions are subject to closing without notice.