Claims Examiner - Remote

Job Type: Full-time

Work Setup: This is a fully remote position
Work Hours: Pacific Time Zone

We are looking for Experienced Claims Examiner to join our rapidly growing team.

Experience is required for this position.

Job Overview:

As a Claims Examiner, you will be responsible for accurately reviewing, investigating, and processing medical claims and provider dispute requests in accordance with payer guidelines, contractual agreements, regulatory requirements, and internal policies.

Responsibilities:

• Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies.
• Review and investigate provider dispute requests, appeals, and reconsiderations related to processed medical claims.
• 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.
• Participate in ongoing training and professional development activities.
• Handle more complex claims with multiple services, providers

Experience:

• At least 1-2 years of experience working closely with healthcare claims or in a claims processing/adjudication environment.
• Experience processing Provider Dispute Resolution (PDR), appeals, reconsiderations, or claim adjustments is highly preferred.
• 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

What We Offer

• Remote work offered
• Equipment provided
• Paid training to set you up for success
• Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
• Paid Time Off (PTO)
• 7 paid holidays
• A supportive team and a company that values internal growth

Ready to Grow Your Career?

We’d love to meet you! Click “Apply Now” and tell us why you’d be a great addition to the Imagenet team.

About Imagenet, LLC

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers.

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.