Claims Examiner: Complex Adjudication & Growth

Univera Healthcare; Buffalo (NY); On-site; USD 42,000 - 69,000; Full time

Benefits offered by this job

Remote work possibility

Job summary

Univera Healthcare is seeking a Claims Examiner to resolve a wide range of claims transactions including entry, adjudication, and adjustment in line with MTM, NCQA, and policy requirements. The role emphasizes accuracy, privacy, and collaboration with internal teams.

The position supports Level I–IV responsibilities, with increasing complexity, a focus on learning, and adherence to corporate standards. Remote work may be considered on a case-by-case basis.

Qualifications

• High School diploma or equivalent required.
• Relevant customer service or claims processing experience preferred.
• Capacity to continuously develop skills.
• Basic computer skills and the ability to navigate in a Windows environment.

Responsibilities

• Handle front end transactions including member eligibility, entry of claims, member & provider matching and claim processing.
• Identify patterns that impact quality, claim inventory, and customer experience and elevate for review.
• Identify potential trends and, if necessary, elevate for investigation/solution.
• Process, enter, adjudicate and/or adjust and research claims.

Skills

Customer service

Claims processing

Multi-tasking

Attention to detail

Windows navigation

Education

High School diploma or equivalent

Tools

Windows OS

Job description

Univera Healthcare is seeking a Claims Examiner to resolve a wide range of claims transactions including entry, adjudication, and adjustment in line with MTM, NCQA, and policy requirements. The role emphasizes accuracy, privacy, and collaboration with internal teams.

The position supports Level I–IV responsibilities, with increasing complexity, a focus on learning, and adherence to corporate standards. Remote work may be considered on a case-by-case basis.