Claims Examiner

About us:

PayerFusion is a healthcare administrative solutions provider that offers health insurers and self-funded employers throughout the US and worldwide with innovative, cost-effective ways to process medical claims, maintain high customer satisfaction levels, and manage healthcare expenses.

The Opportunity:

PayerFusion is looking for an experienced Claims Examiner-Claims Processor to join our dynamic team. The successful candidate will help streamline our claims process and improve customer satisfaction. This is a great opportunity for an individual who enjoys working in a fast-paced, team-oriented environment.

Job Responsibilities:

• Analyze and process claims in accordance with our clients’ policies and procedures.
• Identify and investigate inconsistent or fraudulent claims.
• Liaise with healthcare providers and policyholders regarding claims processing issues.
• Perform regular quality audits on completed claims.
• Document claim process and keep track of claim data for reporting and analysis.

Desired Qualifications:

• At least three years of experience in claims processing, preferably in the health insurance sector.
• Knowledge of medical terminology and International Classification of Diseases (ICD) codes.
• Strong analytical skills and attention to detail.
• Excellent verbal and written communication skills.
• Proficiency in Microsoft Office Suite, especially Excel, and in claims processing software.

Nice-to-Haves:

• Experience with online claim submission platforms.
• Certified Professional Coder (CPC) certification.
• Knowledge of Foreign Language, preferably Spanish.
• Experience with project management.
• Understanding of healthcare compliance and regulations.

Benefits:

• Health, vision, dental, life and hospitalization insurance
• 401K with 4% match
• 12 Holidays Paid
• PTO