Claims Examiner II
HealthEdge · Remote (US)
- Adjudicate healthcare claims using established policies and procedures.
- Review data in the claims processing system to confirm services rendered were appropriate.
- Verify that benefit coverage criteria were met before a claim is paid.
- Apply payer rules and processing standards consistently across each claim.
- Investigate and resolve claims that cannot be processed automatically.
- Keep claim decisions accurate and well documented.
- Meet quality and turnaround standards for each claim reviewed.
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