Remote Claims Examiner - Adjudication & Complex Claims

Lifetime Workforce Solutions, LLC; Texas; On-site; USD 28,000 - 46,000; Full time

Job summary

Lifetime Healthcare Companies is seeking a Claims Examiner to resolve a wide range of claims tasks, including entry, adjudication, adjustment and eligibility checks, while ensuring privacy and compliance with MTM and NCQA requirements.

The role spans Level I through Level IV accountabilities, demanding attention to detail, multi-tasking, strong communication with internal teams, and the ability to handle varying claim complexities; a high school diploma or equivalent is required.

Qualifications

• High School diploma or equivalent required.
• Relevant customer service or claims processing experience preferred.
• Ability to handle moderately complex claims processing with accuracy.

Responsibilities

• Handle front end transactions including member eligibility and claim processing.
• Process, adjudicate and adjust claims; research when needed.
• Collaborate with internal departments and maintain privacy compliance.
• Scale responsibilities across Level I–IV with increasing complexity.

Skills

Customer service

Claims processing

Multi-tasking

Attention to detail

Self-management

Windows environment

Education

High School diploma or equivalent

Job description

Lifetime Healthcare Companies is seeking a Claims Examiner to resolve a wide range of claims tasks, including entry, adjudication, adjustment and eligibility checks, while ensuring privacy and compliance with MTM and NCQA requirements.

The role spans Level I through Level IV accountabilities, demanding attention to detail, multi-tasking, strong communication with internal teams, and the ability to handle varying claim complexities; a high school diploma or equivalent is required.