Medical Claims Examiner: Precise Adjudication & Coding

Benefit & Risk Management Services, Inc.; Folsom, Northern (CA, KY); Hybrid; USD 52,000 - 78,000; Full time

Job summary

Benefit & Risk Management Services, Inc. is seeking a Claims Examiner I to ensure claims are coded and processed accurately and to meet production targets.

The role involves reviewing policy data, adjudicating medical claims, applying plan guidelines, and gathering documentation for final payment determinations. The position requires strong communication and analytical skills, proficiency with ICD-10, CPT, and HCPCS codes, and the ability to work effectively in an office environment.

Qualifications

• Associate degree or equivalent.
• 3-5 years employee benefits/claims examiner experience.
• Ability to read, speak, and write English.

Responsibilities

• Compare claim data with policy and records to assess completeness and validity.
• Adjudicate medical claims in line with plan guidelines and COB.
• Gather documentation from providers to determine final payments.
• Maintain coding accuracy and meet production targets.

Skills

Communication

Analytical skills

Data entry

ICD-10 CPT HCPCS knowledge

Education

Associate degree or equivalent

Tools

Word

Excel

Outlook

Job description

Benefit & Risk Management Services, Inc. is seeking a Claims Examiner I to ensure claims are coded and processed accurately and to meet production targets.

The role involves reviewing policy data, adjudicating medical claims, applying plan guidelines, and gathering documentation for final payment determinations. The position requires strong communication and analytical skills, proficiency with ICD-10, CPT, and HCPCS codes, and the ability to work effectively in an office environment.