Medical Claims Examiners

Job Description

Are you an experienced Medical Claims Adjuster in the Annapolis, MD area seeking a great career opportunity? Have you recently been looking for prestigious, national healthcare companies to further your long-term goals? Are you seeking real advancement opportunities in-house with a Fortune 500 company? If you answered “yes” to any of these questions – then this opportunity may be for you!

Preference will go to candidates who have current or previous experience from Care First, Blue Cross, or other major insurance payor companies. We are looking for employees that understand PPO plans and have worked on the commercial line of business. Knowledge of processing physician claims, hospital claims, and ICD-10 is required.

Daily Responsibilities:

Responsible for the accurate and timely adjudication of all claims in accordance with applicable contracts, state and federal regulations, health plan requirements, policies and procedures, and generally accepted business practices. Reviews providers' disputes and appeals for professional and hospital claims to determine resolution according to policies and procedures. Adheres to state and federal policies and procedures when adjudicating claims, including but not limited to interest calculation and resolution timeliness.

Pay: $18-22/hr (solely based on experience; higher pay may be considered)

Advantages of this Opportunity:

• Competitive hourly pay above regional average!
• Long-term stability and individual professional growth potential from a national healthcare company that continues to grow!
• You will have the opportunity to add great experience to your resume, while getting the chance to network with several future colleagues in a highly competitive insurance claims field.

• Verifiable high school diploma or GED
• Ability to pass a national background check and 10-panel drug test
• 1+ years of processing managed care medical claims
• Knowledge of medical terminology
• Working knowledge of ICD-9-CM, CPT, HCPCS, RBRVS coding schemes
• Experience with different software and hardware systems for claims adjudication
• Accurate input of data for claims adjudication including diagnostic and procedural coding, pricing schedules, member and provider identification, etc.