Medicaid Claims Examiner II

HealthEdge • Remote,

2d • Remote

About The Position

HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology. Learn more at HealthEdge.com.
HealthEdge is looking for Claims Examiner II, reporting to the Claims Team Leader. The Claims Examiner II is responsible for the adjudication of healthcare claims utilizing specific policies and procedures. This role is responsible for reviewing data within the claims processing system, to determine if services rendered were appropriate and benefit coverage criteria were met. The Claims Examiner II is accountable for reviewing the adjudication system edits to determine whether to pay the claim and/or line item(s).

Requirements

• High School degree required
• 1 – 3 years healthcare claims processing experience
• Solid understanding and ability to analyse claim data
• Willingness to learn new skills
• Team collaborator
• Strong work ethic

Nice To Haves

• ICD-10 CPT and HCPCS coding, is a plus
• The ability to adapt quickly to a fast-paced environment
• A self-starter and quick learner
• Team player with an ability to collaborate

Responsibilities

• Processing assigned claims based on client-specified guidelines or as directed by the team leader
• Meeting productivity targets, financial and procedural accuracy standards as established by management
• Mentoring junior members of the team
• Collaborating with other team members on special projects as assigned by the team leads; special projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), or any other project as determined by the team leader
• Establishing and maintaining an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure processing accuracy and quality
• Participating in projects assigned by the team leader; these projects may include provider data, authorizations, enrollment, or other activities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED