Medical Claims Examiner

Who We Are

Lawelawe is a Native Hawaiian Owned Small Disadvantaged Business (NHO SDB) that specializes in providing a range of services to federal government clients, including program management, digital solutions, human capital and training, and medical staffing. Lawelawe leverages our NHO status to secure federal contracts that not only drive business success but also support our overall mission to uplift economically disadvantaged Native Hawaiian families and preserve the Native Hawaiian heritage.

You are a detail oriented Medical Claims Examiner professional with experience supporting medical claims, insurance claims, healthcare administration, billing, collections, case management, records management.

You can accurately manage sensitive medical, financial, and legal information while working across multiple electronic systems. You are organized, dependable, and capable of following established procedures while meeting productivity, accuracy, quality, and timeliness requirements. You communicate professionally and understand the importance of safeguarding private and sensitive information.

You will support medical claims and healthcare cost recovery activities for a federal healthcare customer. Your work will help identify responsible third parties, process claims, track payments, maintain accurate case files, and recover healthcare costs owed to the government.

Your attention to detail and commitment to quality will help ensure claims are properly documented, processed, tracked, and resolved in accordance with government procedures.

• Monitor shared organizational email inboxes and physical mail for incoming claims, correspondence, and inquiries.
• Process new referrals and establish Medical Affimative Claims and Third-Party Collection case files.
• Enter claims and case information into ACMP and other required government systems.
• Maintain accurate electronic case files, tracking logs, correspondence, and supporting documentation.
• Research and collect authorized patient, beneficiary, treatment, billing, insurance, eligibility, and case-related information.
• Access medical, administrative, eligibility, and financial systems to obtain records, treatment timelines, billing statements, patient demographics, and related information.
• Verify patient and claim information and identify missing, inaccurate, or inconsistent data.
• Gather and organize medical records, accident reports, insurance information, billing data, and supporting documents for review.
• Properly name, index, upload, and maintain documents in SharePoint and government case-management systems.
• Record Third-Party Collection denial codes and payer responses.
• Complete standardized appeal templates and assemble appeal packages for higher-level review.
• Research potentially liable parties, insurance carriers, civilian attorneys, and other relevant entities.
• Prepare notices of claim using government-approved templates.
• Draft standard demand letters, settlement memoranda, and other routine correspondence for review and signature by authorized government personnel.
• Prepare and mail claims forms and supporting documentation when electronic submission is unavailable.
• Respond professionally to routine inquiries from insurance carriers, attorneys’ offices, healthcare organizations, government personnel, and other authorized parties.
• Provide approved, non-sensitive documentation in accordance with government direction.
• Update case status information within required time frames.
• Track case milestones, correspondence, follow-up actions, payment activity, and statute-of-limitations deadlines.
• Perform data cleanup and first-level quality reviews of claims, reports, case files, and supporting documentation.
• Process…