Claims Examiner II

About This Opportunity

We are representing a confidential healthcare technology organization in their search for a Claims Examiner II. This remote position offers the opportunity to work with modern claims administration systems while supporting healthcare payers in delivering efficient, member-focused experiences.

Our client operates business process services for health insurance organizations, and this role will focus on accurate claims adjudication while mentoring team members and contributing to process improvements.

Responsibilities

• Process healthcare claims according to client-specific guidelines and payer policies
• Review claims data and system edits to determine appropriate payment decisions
• Evaluate whether services rendered meet benefit coverage criteria and medical necessity requirements
• Meet established productivity targets and maintain financial and procedural accuracy standards
• Mentor junior claims examiners and support their professional development
• Collaborate on special projects including process documentation, training materials, quality audits, and surge support
• Maintain clear communication with management regarding processing issues, concerns, and quality measures
• Participate in cross-functional projects involving provider data, authorizations, or enrollment activities

What We're Looking For

• High school diploma required
• 1–3 years of healthcare claims processing experience
• Strong ability to analyze claims data and apply payer policies accurately
• Knowledge of physician practices, hospital coding and billing, and medical terminology
• Familiarity with CPT, HCPCS, ICD-10, UB04, and CMS 1500 forms
• Understanding of authorizations and healthcare concepts
• Experience with coding (ICD-10, CPT, HCPCS) is a plus
• Self-starter who adapts quickly to fast-paced environments
• Team player with strong collaboration skills and willingness to learn
• Strong work ethic and attention to detail

Location: Remote, United States
Employment Type: Full-time, permanent

How We Work With You

Candidates apply directly through Get A Job.ai. Our talent team will conduct an initial screening to understand your background and claims processing experience. Qualified candidates will then be submitted to our client for consideration. Please do not attempt to contact the client directly, as all communications are coordinated through our recruiting team to ensure a professional process.

Pay

Pay via Get A Job.ai: $17.00 to $19.00 per hour, based on your experience, skills, and qualifications.

Equal Employment Opportunity: Get A Job.ai is committed to diversity and inclusion in our recruiting process. We work with clients who value equitable hiring practices and encourage applications from all qualified candidates regardless of race, ethnicity, gender, veteran status, disability, or other protected characteristics.