Claims Examiner

About This Role

Examining and adjudicating healthcare claims is the core of this role, applying established policies, procedures, and processing standards. This full-time weekday opportunity is ideal for an experienced claims professional with strong attention to detail, sound judgment, and a commitment to quality.

Responsibilities

• Review and adjudicate routine and non-routine healthcare claims
• Evaluate claims for accuracy, completeness, and appropriate processing
• Apply established claims policies, procedures, and standards
• Research and resolve claim discrepancies
• Meet established processing timelines and quality expectations
• Maintain accurate claims documentation
• Process routine and non-routine claims using established claim standards, and departmental policies and procedures
• Accurately evaluate and adjudicate claims in a timely manner and according to set standards

Requirements

• Minimum of 2 years of healthcare claims experience
• Strong attention to detail and analytical skills
• Ability to interpret and apply policies and procedures
• Strong organizational and problem-solving skills
• 2-3 years relevant experience in health care claims and customer service
• Knowledge of Medical Terminology, Medical Insurance, and must be computer literate
• High School Diploma or GED preferred

Benefits

• Comprehensive benefits for eligible employees
• Paid time off and paid holidays
• Professional development opportunities
• Supportive and collaborative work environment
• Opportunities for career growth
• 401K retirement plan
• Medical, dental, and vision coverage
• Tuition reimbursement
• Many more voluntary benefit options

Important Details

• Schedule: Weekdays
• Department: Claims
• Employment Status: Full Time
• Shift: Days

About the Company

Desert Valley Medical Group offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs.