Senior Medical Claims Examiner - Remote

Allied Benefit Systems; Chicago (IL); Remote; USD 48,000 - 72,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Tuition reimbursement

EAP

Job summary

Allied is seeking a Claims Examiner to determine proper payment of medical claims for group health plans. You will review claims for reasonableness, medical necessity, and potential fraud, and determine benefit levels.

This remote role requires strong analytical skills, knowledge of CPT/ICD-9 coding, and adherence to HIPAA standards. A minimum of five years’ claims analysis experience is required, with a focus on accuracy and efficiency.

Qualifications

• 5+ years of medical claims analysis experience (including dental and vision claims analysis).
• Strong analytical skills; able to review claims for billing irregularities and medical necessity.
• Knowledge of CPT and ICD-9 coding terminology.
• Continuing education in all areas affecting group health and welfare plans is required.

Responsibilities

• Independently review and analyze health care claims for reasonableness of cost and medical necessity.
• Determine benefit payments and communicate coverage decisions to providers.
• Log claims and prepare weekly summary reports in the system.
• Review and understand the terms of each client’s customized plans and stay HIPAA compliant.

Skills

5+ years medical claims analysis

Analytical skills

CPT/ICD-9 coding knowledge

Continuing education

Education

High School Diploma / College and Advanced Degrees Preferred

Job description

Allied is seeking a Claims Examiner to determine proper payment of medical claims for group health plans. You will review claims for reasonableness, medical necessity, and potential fraud, and determine benefit levels.

This remote role requires strong analytical skills, knowledge of CPT/ICD-9 coding, and adherence to HIPAA standards. A minimum of five years’ claims analysis experience is required, with a focus on accuracy and efficiency.