2 claims examiner ii jobs found

Med Bill Examiner III - CJ10AN We’re determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals – and to help others accomplish theirs, too. Join our team as we help shape the future.              The Medical Bill Examiner III is an experienced claims professional responsible for the accurate review, analysis, and adjudication of complex medical bills. This role applies advanced knowledge of medical billing practices, coding standards, fee schedules, and regulatory requirements to ensure compliance, accuracy, and cost containment. The Med Bill Examiner III functions with a high level of independence and may serve as a subject matter resource for lower‑level examiners. Start Date :  September 14, 2026 Hours: 8:00 AM - 5:00 PM / Monday-Friday Eastern Time Zone   Key Responsibilities Review, audit, and adjudicate complex medical...

The Professional Review Specialist analyzes medical services and billing across various claim types to evaluate the accuracy of charges and the medical necessity of care provided.  This is a hybrid role. Training is onsite Full Time, then Hybrid once trained . ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and or direct reporting manager Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans Appropriately document work and final conclusions in designated computer program Additional duties as assigned   KNOWLEDGE & SKILLS: Thorough knowledge of ICD Diagnoses and Procedure Codes, and C.P.T., as well as an understanding of medical terminology Knowledge of applicable fee schedule and or applicable U&C Guidelines...