Remote Medicare Claims Specialist II

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

Job summary

HealthEdge is seeking a Medicare Claims Examiner II to adjudicate healthcare claims using policy guidelines, reviewing data in claims system to determine coverage and payments. This remote, US-based role reports to the Claims Team Leader and requires 1–3 years of claims processing experience.

You will meet productivity and accuracy targets, mentor junior teammates, and participate in projects like process documentation and quality audits, while expanding your knowledge of CPT, ICD-10, HCPCS, and

Qualifications

• 1–3 years healthcare claims processing experience.
• Solid ability to analyse claim data.
• Knowledge of ICD-10, CPT and HCPCS coding is a plus.
• Willingness to learn new skills; team-oriented and reliable.

Responsibilities

• Process assigned claims based on client guidelines or as directed by the team leader.
• Meet productivity targets and accuracy standards.
• Mentor junior team members.
• Collaborate on special projects and process improvements.
• Maintain knowledge of physician practices and coding terminology.

Skills

Claims processing

Data analysis

Healthcare coding

Team collaboration

Willingness to learn

Communication

Education

High School diploma

Job description

HealthEdge is seeking a Medicare Claims Examiner II to adjudicate healthcare claims using policy guidelines, reviewing data in claims system to determine coverage and payments. This remote, US-based role reports to the Claims Team Leader and requires 1–3 years of claims processing experience.

You will meet productivity and accuracy targets, mentor junior teammates, and participate in projects like process documentation and quality audits, while expanding your knowledge of CPT, ICD-10, HCPCS, and