Senior Remote Managed Care Claims Examiner

Imagenet, LLC; Tampa (FL); Remote; USD 52,000 - 72,000; Full time

Benefits offered by this job

Health benefits

Job summary

Imagenet is seeking an Experienced Managed Care Claims Examiner to join our remote team. This role handles review, adjudication, and resolution of medical claims and provider dispute requests in line with payer guidelines and regulatory requirements.

The ideal candidate will possess at least 3 years of healthcare claims adjudication experience, strong analytical abilities, and a commitment to accuracy and professional growth.

Qualifications

• Minimum 3 years of healthcare claims adjudication experience.
• Experience processing medical claims from initial review through final adjudication.
• Strong understanding of healthcare claims processing and reimbursement principles.
• Excellent attention to detail and sound decision-making.

Responsibilities

• Review and adjudicate medical claims with accurate coding and appropriate reimbursement methodologies.
• Process a broad range of claim types, including professional, institutional, and complex scenarios.
• Investigate provider dispute requests (PDRs), appeals, reconsiderations, and claim adjustments.
• Verify member eligibility, provider participation, and benefit coverage.
• Document decisions and actions thoroughly throughout the adjudication process.
• Collaborate with internal stakeholders to resolve claim-related issues.
• Maintain high productivity while upholding quality and timeliness standards.

Skills

Healthcare claims adjudication

Claims processing

Analytical skills

Attention to detail

Communication

Microsoft Office

Tools

Microsoft Excel

Job description

Imagenet is seeking an Experienced Managed Care Claims Examiner to join our remote team. This role handles review, adjudication, and resolution of medical claims and provider dispute requests in line with payer guidelines and regulatory requirements.

The ideal candidate will possess at least 3 years of healthcare claims adjudication experience, strong analytical abilities, and a commitment to accuracy and professional growth.