Claims Examiner

Addison Group; Tulsa (OK); On-site; USD 52,000 - 66,000; Full time

Benefits offered by this job

Competitive pay

Medical/dental/vision

401(k)

Paid time off

EAP & wellness

Professional development

Collaborative environment

Job summary

Addison Group in Tulsa, OK is seeking a Benefits Review Specialist to review, evaluate, and process healthcare claims with accuracy and regulatory compliance.

The ideal candidate will have strong attention to detail, solid communication skills with providers and clients, and the ability to manage multiple priorities in a collaborative, team‑oriented environment.

Direct hire role with a $28/hr pay, Mon-Fri 8am-5pm schedule, and benefits including medical, dental, vision, and 401(k).

Qualifications

• High school diploma or equivalent required.
• At least 1 year of experience in healthcare claims processing.
• Ability to interpret policies and government regulations.
• Proficiency with standard computer applications.
• Strong attention to detail and analytical skills.
• Effective written and verbal communication.
• Ability to manage multiple priorities.

Responsibilities

• Review submitted claims to verify eligibility and coverage.
• Evaluate claims using plan provisions and guidelines.
• Determine claim outcomes including approvals, adjustments, or denials.
• Prepare or coordinate claim-related correspondence.
• Maintain accurate records of claims and payments.
• Respond to questions from providers and clients about status.
• Identify discrepancies and escalate as needed.

Skills

Attention to detail

Communication skills

Analytical thinking

Regulatory interpretation

Time management

Team collaboration

HIPAA compliance

Education

High School Diploma or equivalent

Tools

Email

Spreadsheets

Word Processing

Database systems

Job description

• Determine appropriate claim outcomes, including approvals, adjustments, payment calculations, or denial determinations.

Job Title

Benefits Review Specialist

Industry

Insurance / Healthcare

Location (city, state)

Tulsa, OK

Assignment Type

Direct Hire

Pay

$28/hr

Work Schedule

Mon-Fri, 8am-5pm

Benefits

This position is eligible for medical, dental, vision, and 401(k).

About The Company

Our client is an established organization within the insurance and healthcare services industry focused on delivering accurate, timely, and high-quality claims support. The team values collaboration, attention to detail, continuous improvement, and providing responsive service to clients and business partners.

Job Description

The Claims Examiner will be responsible for reviewing, evaluating, and processing healthcare-related insurance claims. This position requires a strong understanding of claims procedures, benefit information, documentation requirements, and applicable regulations. The ideal candidate is detail-oriented, analytical, organized, and able to communicate effectively with both internal and external stakeholders.

Key Responsibilities

• Review submitted claims to verify eligibility, required documentation, accuracy, and applicable coverage.
• Evaluate claims using plan provisions, established procedures, and applicable benefit guidelines.
• Determine appropriate claim outcomes, including approvals, adjustments, payment calculations, or denial determinations.
• Prepare or coordinate claim-related correspondence when additional information or a denial explanation is required.
• Follow applicable federal and state regulations, privacy requirements, and internal claims procedures.
• Maintain complete and accurate records of claims, payments, adjustments, denials, and supporting documentation.
• Respond to questions from healthcare providers, clients, and internal teams regarding claim status and processing decisions.
• Identify potential payment discrepancies, including overpayments and underpayments, and elevate issues appropriately.
• Communicate with external partners and other stakeholders to obtain information necessary to complete claim reviews.
• Confirm member eligibility, benefit levels, authorizations, and coverage details as needed.
• Recognize missing or inconsistent documentation and work with the appropriate parties to resolve outstanding issues.
• Protect confidential information and follow HIPAA and other applicable privacy standards.
• Utilize claims systems, computer applications, and emerging technology tools to improve accuracy, efficiency, and service.
• Contribute to departmental projects, process improvements, and other duties as assigned.

Qualifications

• High school diploma or equivalent required.
• At least 1 year of experience in healthcare claims processing, reimbursement, or a related field.
• Ability to interpret written policies, benefit information, procedural guidelines, and government regulations.
• Proficiency with standard computer applications, including email, spreadsheets, word processing, and database systems.
• Strong attention to detail and the ability to analyze information and identify discrepancies.
• Effective problem-solving and decision-making skills.
• Strong written and verbal communication abilities.
• Ability to manage multiple priorities and adjust to changing workloads.
• Ability to work effectively with internal teams, providers, clients, and other business partners.

Additional Details

• This position requires a high level of accuracy and discretion when handling sensitive claims and member information.
• Candidates should be comfortable working independently while also collaborating with a broader team.
• The responsibilities listed above are representative of the position and may be modified based on business needs.

Perks

• Competitive compensation.
• Medical, dental, and vision benefits.
• 401(k) retirement savings opportunity.
• Paid time off and company holidays.
• Employee assistance and wellness resources.
• Professional development and career growth opportunities.
• Collaborative and supportive work environment.

Equal Opportunity Employer Statement

Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.