Claims Examiner: Medical Benefits Adjudication

BRMS; Folsom (CA); On-site; USD 52,000 - 75,000; Full time

Job summary

BRMS is seeking a Claims Examiner I to ensure accurate coding and processing of medical claims. The role involves adjudicating claims, applying plan guidelines, and coordinating with providers to gather necessary documentation for final payment determinations.

The ideal candidate has 3–5 years of employee benefits industry experience, strong data-entry and analytical skills, and proficiency in Word, Excel, and Outlook.

Qualifications

• Associate degree or equivalent required.
• 3–5 years employee benefits industry/claims examiner experience preferred.
• Proficiency with ICD-10, CPT, and HCPCS codes essential.

Responsibilities

• Compare claim data with policy and records for completeness and validity.
• Adjudicate medical claims and determine final payment.
• Ensure correct claim coding and documentation.
• Process claims within standard production timelines (3–5 days).
• Research escalations and resolve paid/denied claims.
• Coordinate with providers to obtain necessary documents.

Skills

Communication skills

Analytical skills

Data entry

Microsoft Office

Education

Associate degree

3–5 years claims experience

Tools

Word

Excel

Outlook

Job description

BRMS is seeking a Claims Examiner I to ensure accurate coding and processing of medical claims. The role involves adjudicating claims, applying plan guidelines, and coordinating with providers to gather necessary documentation for final payment determinations.

The ideal candidate has 3–5 years of employee benefits industry experience, strong data-entry and analytical skills, and proficiency in Word, Excel, and Outlook.