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Job ID: 13923

Job title: Medical Claims Examiner

Location: Clearwater, 33760

Pay: $37,440

Hours: 8-5

Type: Direct Hire

Assignment duration: Direct Hire

Quantity: 2

Job duties:

  1. Reviews and adjudicates medical claims based on health policy provisions and established guidelines
  2. Requests additional information from members and providers as needed
  3. Initiates and completes claim investigations when indicated including pre-existing conditions, accidents, medical necessity and appropriateness, eligibility and coordination of benefits
  4. Documents fully claims referred to senior staff for review and determination

Requirements:

  • Required: The ability to read claims forms with medical claims experience, experienced with repetitive work (no research)
  • Minimum one (1) year of medical claims processing experience
  • High school diploma or equivalent is required
     

 

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