Remote Medicare Claims Examiner II

HealthEdge; United States; Remote; USD 42,000 - 66,000; Full time

Job summary

HealthEdge seeks a Claims Examiner II to adjudicate health insurance claims using client guidelines and policy procedures. The role involves reviewing data in the claims system to ensure services meet coverage criteria and are paid correctly.

You will process claims, meet productivity and accuracy targets, mentor junior staff, and collaborate on special projects such as documentation, audits, and process improvements. ICD-10/CPT/HCPCS knowledge is a plus.

Qualifications

• 1–3 years of healthcare claims processing experience.
• Familiarity with ICD-10, CPT, HCPCS coding is a plus.
• Strong analytical skills and attention to detail.

Responsibilities

• Process assigned claims based on client guidelines and team direction.
• Meet productivity and accuracy targets as defined by management.
• Mentor junior team members and share best practices.
• Collaborate on special projects including process documentation and quality audits.
• Maintain knowledge of physician practices, coding, and medical terminology.
• Communicate with management to address issues and improve processing quality.
• Participate in projects related to provider data, authorizations, enrollment.

Skills

Healthcare claims processing

ICD-10 CPT HCPCS coding

Analytical skills

Team collaboration

Willingness to learn

Job description

HealthEdge seeks a Claims Examiner II to adjudicate health insurance claims using client guidelines and policy procedures. The role involves reviewing data in the claims system to ensure services meet coverage criteria and are paid correctly.

You will process claims, meet productivity and accuracy targets, mentor junior staff, and collaborate on special projects such as documentation, audits, and process improvements. ICD-10/CPT/HCPCS knowledge is a plus.