Remote Medicaid & Medicare Claims Examiner II

HealthEdge; United States; Remote; USD 55,000 - 75,000; Full time

Job summary

HealthEdge seeks a Claims Examiner II to adjudicate healthcare claims in a remote US setting. You’ll review claims, apply client guidelines, and determine eligibility and payment per policy.

You will also mentor junior staff and collaborate on special projects to improve processes and accuracy. The role requires 1–3 years of claims experience, strong data analysis, and a readiness to learn in a fast-paced environment.

Qualifications

• High School degree required.
• 1–3 years healthcare claims processing experience.
• Solid understanding and ability to analyse claim data.
• ICD-10, CPT, and HCPCS coding is a plus.
• Willingness to learn and collaborate with the team.
• Strong work ethic and reliability.

Responsibilities

• Process assigned claims based on client guidelines or team leader direction.
• Meet productivity, financial, and accuracy standards.
• Mentor junior team members.
• Collaborate on special projects and process improvements.
• Maintain knowledge of coding, billing terminology, and claim criteria.
• Communicate with management to address issues and ensure quality.
• Participate in projects related to provider data, authorizations, enrollment, or similar activities.

Skills

Healthcare claims processing

Data analysis

Team collaboration

Willingness to learn

Strong work ethic

Adaptability in fast-paced environment

Education

High School degree

Job description

HealthEdge seeks a Claims Examiner II to adjudicate healthcare claims in a remote US setting. You’ll review claims, apply client guidelines, and determine eligibility and payment per policy.

You will also mentor junior staff and collaborate on special projects to improve processes and accuracy. The role requires 1–3 years of claims experience, strong data analysis, and a readiness to learn in a fast-paced environment.