Claims Examiner Remote (Plano, TX, US)

About This Opportunity

We are representing a confidential healthcare organization seeking a Claims Examiner to join their team remotely from the Plano, Texas area. Our client processes professional healthcare claims and requires an experienced examiner who can work independently while maintaining exceptional quality standards.

Responsibilities

• Process professional claim forms and files submitted by healthcare providers
• Review policies and benefits to ensure accurate claim adjudication
• Maintain strict compliance with HIPAA, confidentiality regulations, and protected health information (PHI) protocols
• Work independently to research, review, and take action on claims within established workflows
• Prioritize work to meet turnaround time requirements and service level agreements (SLAs)
• Adjudicate claims according to defined guidelines and methodologies
• Sustain productivity and quality targets, maintaining quality scores above 98.5% processing accuracy and 99.75% financial accuracy
• Respond to and resolve priority claims received via email in a timely manner
• Calculate claims payable amounts using applicable fee schedules and methodologies
• Navigate multiple computer systems and screens efficiently throughout the workday

What We're Looking For

Required Qualifications:

• High school diploma or GED
• 3+ years of hands-on experience in healthcare claims processing
• 2+ years using Windows applications, keyboard navigation, and multiple software systems
• Proven track record working in a productivity and quality-focused environment
• Experience working from a claims queue in a remote setting
• Proficiency with MS Office products including Outlook, Word, and Excel
• Strong keyboard skills with the ability to toggle between multiple screens and systems
• Excellent written and verbal communication skills
• Strong research, analysis, and problem-solving abilities
• Effective time management skills and ability to adapt in a dynamic environment

Preferred Experience:

• Familiarity with Amisys claims processing system

How We Work With You

When you apply through Get A Job.ai, our recruiting team will review your qualifications and conduct an initial screening. If there's a strong match, we'll submit your profile to our client for consideration. Please do not attempt to contact the client directly, as all applications must go through our talent team to be considered for this confidential search.

Pay

Compensation details will be discussed with qualified candidates during the screening process.

Equal Employment Opportunity: Get A Job.ai is committed to creating an inclusive environment. We consider all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.