Claims Examiner - Remote

About the position Imagenet LLC is a premier healthcare technology company revolutionizing medical claims processing as well as document management with unparalleled service, security, and efficiency. Our core mission is to help clients reduce costs and increase productivity by providing streamlined solutions in document imaging, data validation, adjudication, and on-demand retrieval of documents and data. We are looking for Experienced Claims Processor to join our rapidly growing team. Experience is required for this position. In this role, you will be responsible for accurately and efficiently processing medical claims in compliance with payer requirements and internal policies.

Responsibilities

• Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies.
• Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing.
• Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues.
• Participate in ongoing training and professional development activities.
• Maintain accurate and detailed records of claims processing activities.
• Review claim forms and supporting documents
• Determine eligibility, verify data accuracy
• Request additional information when needed
• Process claims end-to-end
• Identify and escalate complex or unusual claims for further review or investigation.
• Handle more complex claims with multiple services, providers

Requirements

• At least 1-2 years of experience working closely with healthcare claims or in a claims processing/adjudication environment.
• Understanding of health claims processing/adjudication
• Ability to perform basic to intermediate mathematical computation routines
• Medical terminology strongly preferred
• Understanding of ICD-9 & ICD-10
• Basic MS office computer skills
• Ability to work independently or within a team
• Time management skills
• Written and verbal communication skills
• Attention to detail
• Must be able to demonstrate sound decision-making skills

Nice-to-haves

• Medical terminology strongly preferred

Benefits

• Remote work offered
• Equipment provided
• Paid training
• Medical
• Dental
• Vision
• Life
• HSA
• 401(k)
• Paid Time Off (PTO)
• 7 paid holidays