Claims Examiner

The Jacobson Group; United States; Remote; USD 66,125,000 - 71,635,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) retirement savings plan

Job summary

The Jacobson Group is seeking a detail-oriented Claims Examiner to join our team remotely. You will process hospital and medical claims for self-funded and level-funded groups, determine payable amounts based on plan specifics, and ensure accuracy and policy compliance.

You will collaborate with internal teams to resolve complex claims issues, identify billing discrepancies, and support a high-volume environment while driving process improvements.

Qualifications

• Experience processing hospital and medical claims for self-funded and level-funded groups.
• Strong communication skills and sound judgment.
• Attention to detail and ability to thrive in a fast-paced team environment.
• Ability to manage multiple priorities and quickly learn new systems and processes.
• Familiarity with CRM, Beacon Claims Administrative System, Microsoft Office and Teams, and AI-enabled service tools.

Responsibilities

• Process hospital and medical claims for self-funded and level-funded groups.
• Determine payable amounts, including deductibles, co-pays and co-insurance limits based on plan specifics.
• Review, adjust, and process insurance claims to ensure accuracy and policy compliance.
• Identify billing discrepancies, missing documentation or rejected batches and coordinate corrections.
• Collaborate with internal teams to resolve complex claims issues and drive ownership through resolution.
• Support high-volume claims processing while identifying recurring trends for process improvements.

Skills

Claims processing

Communication

Attention to detail

Multitasking

CRM

Beacon

Microsoft Office

Teams

AI tools

Tools

Beacon

CRM systems

Microsoft Office

Teams

Job description

We are seeking a detail-oriented Claims Examiner to join our client's team remotely. The successful candidate will process hospital and medical claims for self-funded and level-funded groups, ensuring accuracy and adherence to policy rules. This role involves determining payable amounts, including deductibles, co-pays, and co-insurance limits based on contracted fee schedules and insurance plans. The Claims Examiner will review, adjust and process claims to confirm they are complete, accurate and paid properly. Collaborating with internal teams to resolve complex claims issues and address billing discrepancies will be integral to this position. The ideal candidate will support a high-volume environment, identifying trends and opportunities for improvement.

Responsibilities:

• Process hospital and medical claims for self-funded and level-funded groups.
• Determine payable amounts, deductibles, co-pays and co-insurance limits based on plan specifics.
• Review, adjust, and process insurance claims to ensure accuracy and policy compliance.
• Identify billing discrepancies, missing documentation or rejected batches and coordinate corrections with providers, coders, and internal teams.
• Collaborate with internal teams to resolve complex claims issues, ensuring ownership through resolution.
• Support high-volume claims processing environments while recognizing recurring trends for process improvement.

Requirements:

• Experience claims processing for self-funded and level-funded groups
• Strong communication skills and sound judgment
• Attention to detail and ability to thrive in a fast-paced team environment
• Ability to manage multiple priorities and quickly learn new systems and processes
• Comfort working with CRM, Beacon Claims Administrative System, shared inboxes and workflow tools, Microsoft Office and Teams, and AI-enabled service tools

Pay Range:

The anticipated pay for this position is $24.00 per hour. We understand salary is an important factor in a job search, and we encourage you to apply even if you feel that your desired compensation may fall outside of the listed range. The final pay for this position is determined based on several factors including but not limited to, relevant experience, skills and certifications, education and training, geographic location, market conditions, and internal equity. We are committed to finding the right candidate for this role and are open to discussing how your unique qualifications align with our needs.

Benefits:

• Medical insurance
• Dental insurance
• Vision insurance
• 401(k) retirement savings plan

Equal Opportunity Employer:

The Jacobson Group is committed to fostering an inclusive and equitable workplace that reflects the diverse communities we serve. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status or any other protected characteristic as defined by applicable law. We believe that diversity of thought, background and experience strengthens our team and drives innovation. All employment decisions are based on qualifications, merit and business needs. If you require a reasonable accommodation to complete the application process or participate in an interview, please contact us at [e-mail] or [phone] to make a request.

Contact:

Karrie Ruch
[e-mail]