Healthcare Claims Examiner at CEI Group

*REMOTE Position

Join Our Team as a Healthcare Claims Examiner and Make a Difference in the Lives of Our Customers

As a Claims Examiner you'll have the opportunity to work in a dynamic and supportive environment where no two days are ever the same. In this role, you'll be responsible for processing medical claims, ensuring that our customers receive the benefits they deserve in a timely and accurate manner. If you're a detail-oriented, critical thinker with a passion for delivering exceptional customer service, we want to hear from you!

Responsibilities:

* Process medical claims, including facility and professional claims, in accordance with company policies and procedures
* Verify eligibility of members and ensure accurate benefit payments
* Identify and resolve problems or questionable claim situations
* Generate information requests and declination letters to providers and members
* Review claim documentation and assemble additional information as needed
* Document medical claims actions and maintain accurate records
* Ensure compliance with state and federal regulations, as well as company policies and procedures

Qualifications:

* Bachelor's degree or equivalent job experience
* At least 2 years of experience as a Medical Claims Examiner
* Thorough understanding of group medical claims, including ICD-10, HCPCS/CPT coding, HCFA 1500 and UB92
* Knowledge of claims editing and submission capabilities
* Strong analytical and problem-solving skills
* Excellent communication and interpersonal skills
* Ability to work collaboratively in a team environment

Preferred Qualifications:

* Javelina application experience
* CEBS (Certified Employee Benefits Specialist) certification or life and health insurance license