Medical Claims Examiner

Medical Claims Examiner

Premier Administrative Solutions | Clearwater, FL, US
Salary Range:$31,000 – $47,000 Salary range estimated by Zippia

Posted 15 days ago

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Health Insurance Medical Claims Examiner (Hybrid Work Opportunity)


Minimum 2-3 years of medical claims processing experience required.

The Medical Claims Examiner adjudicates medical claims based on health policy provisions and established guidelines.

Opportunity to work hybrid after 2-3 months of on-site paid training (Mondays and Fridays will be the remote work days)
Monday-Friday Schedule with daytime hours


Essential Duties and Responsibilities:

Reviews and adjudicates medical claims based on health policy provisions and established guidelines
Requests additional information from members and providers as needed
Initiates and completes claim investigations when indicated including pre-existing conditions, accidents, medical necessity and appropriateness, eligibility and coordination of benefits
Documents fully claims referred to senior staff for review and determination
Maintains company production and quality standards
Participates in training

Other Responsibilities:

Adheres to the policies and procedures of Premier Administrative Solutions
Maintains strict confidentiality of client, company and personnel information
Demonstrates a strong commitment to the mission and values of the organization
Adheres to company attendance standards
Performs other duties as assigned

Supervisory Responsibilities: None


Strong organizational and interpersonal skills
Excellent written and verbal communication skills
Detail oriented
Ability to multi-task and work independently
Knowledge of medical and dental coding systems
Knowledge of medical terminology


Minimum 2-3 year of medical claims processing experience required.

Candiidates will be required to take a 30 questions Claims Processing knowledge test prior to hire.

Education and/or Experience:

High school diploma or equivalent is required

Certificates, Licenses, Registrations:


Computer Skills:

Proficiency using software programs such as MS Word, ACCESS, PowerPoint, Excel and Outlook

Environmental Factors/Physical Demands:

Work is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subject to bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds.

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