Remote Claims Examiner - Complex Adjudication & Mentorship

Univera HealthСare; DeWitt (MI); Hybrid; USD 28,000 - 45,000; Full time

Job summary

Univera Healthcare in Michigan is seeking a Claims Examiner to resolve a wide variety of claims transactions, from entry and adjudication to simple adjustments, aligned with MTM, NCQA, and corporate policies.

The role progresses through Level I to IV, with increasing complexity, requiring accurate processing, risk awareness, and effective collaboration with internal teams.

This position may offer remote work on a case-by-case basis.

Qualifications

• High School diploma or equivalent required.
• Experience in customer service or claims processing preferred.
• Ability to navigate Windows environment and multiple programs.
• Valid NYS Independent Adjuster License preferred or required.

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/or the customer experience and escalate for review.
• Process, enter, adjudicate and/or adjust and research claims following procedures.
• Collaborate with internal/external customers to promote satisfaction.
• Maintain privacy in accordance with corporate policies.

Skills

Customer service

Attention to detail

Multi-tasking

Communication with customers

Self-management

Problem solving

Education

High School diploma or equivalent

NYS Independent Adjuster License

Job description

Univera Healthcare in Michigan is seeking a Claims Examiner to resolve a wide variety of claims transactions, from entry and adjudication to simple adjustments, aligned with MTM, NCQA, and corporate policies.

The role progresses through Level I to IV, with increasing complexity, requiring accurate processing, risk awareness, and effective collaboration with internal teams.

This position may offer remote work on a case-by-case basis.