Med Bill Examiner III

The Hartford • Hartford, CT

8d • Hybrid

About The Position

The Medical Bill Examiner III is an experienced claims professional responsible for the accurate review, analysis, and adjudication of complex medical bills. This role applies advanced knowledge of medical billing practices, coding standards, fee schedules, and regulatory requirements to ensure compliance, accuracy, and cost containment. The Med Bill Examiner III functions with a high level of independence and may serve as a subject matter resource for lower‑level examiners.

Requirements

• Advanced experience in medical bill review, claims adjudication, or medical billing audit.
• Strong working knowledge of medical coding (CPT, HCPCS, ICD), fee schedules, and billing regulations.
• Certified Professional Coder (CPC).
• Demonstrated analytical, investigative, and critical‑thinking skills.
• High attention to detail with strong documentation discipline.
• Ability to manage workload independently while meeting accuracy and turnaround expectations.
• Effective written and verbal communication skills.
• Comfort handling complex or disputed billing scenarios.

Nice To Haves

• Experience in workers’ compensation, auto, or group health medical billing.
• Prior exposure to regulatory or compliance‑driven environments.
• Experience functioning as a senior or lead examiner.

Responsibilities

• Review, audit, and adjudicate complex medical bills for accuracy, medical necessity, and compliance with applicable fee schedules, contracts, and regulations.
• Analyze CPT, HCPCS, ICD codes and supporting documentation to identify discrepancies, overbilling, duplicate charges, or non‑covered services.
• Apply state‑specific guidelines, provider contracts, and internal policies when determining appropriate reimbursement.
• Document billing determinations clearly and thoroughly to ensure audit readiness and compliance.
• Communicate billing outcomes, discrepancies, or requests for additional documentation to internal partners, providers, or vendors.
• Resolve billing disputes and escalated issues using sound judgment and investigative analysis.
• Maintain productivity and quality standards in a high‑volume environment.
• Support process improvements and contribute to consistency and best practices across the medical bill review function.
• May mentor or provide guidance to Medical Bill Examiner I or II staff.

Benefits

• Medical, Dental, Vision, Life and Disability Insurance. Effective day 1.
• 25 days paid time off in your first full year and Paid Holidays
• Tuition reimbursement - up to $5,250 (undergraduate) and $6,000 (graduate) for tuition and registration fees for degree programs that support your career development (subject to additional requirements).
• Student Loan Paydown Program – Eligible to participate after 6 months of service. The Hartford will make a direct contribution of $125 per month – with a lifetime maximum up to $10,000 – as a supplemental payment towards your student loan in order to help you manage the stress of student debt and help you pay down your student loan faster.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed