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Claims Examiner (Institutional/Hospital)

Job Description

Sr. Claims Examiner III (Institutional/Hospital)
Complete processing of hospital medical claims including adjudication and accuracy.



  • Accurately process institutional (hospital) claims.
  • Accurately process claims billed on UB04 Claim form.
  • Maintaining/meeting compliance time-frames.
  • Responsible for editing and adjudicating claims.
  • Analyze claims to ensure accurate billing and payment.
  • Interpret contracts and fee schedules.
  • Meet department accuracy and production standards.
  • Interface with other departments to obtain necessary information required for resolution of claims.

Job Requirements

  1. UB Claim form
  2. CPT, ICD-9 Volumes 1,2,3 and HCPCS coding
  3. Revenue centers associated with billing
  4. Hospital, ambulatory surgery center, home health, skilled nursing and dialysis claims
  5. Division of Financial Responsibilities (DOFR)
  6. Understanding of Stop Loss

Job Snapshot

Employment Type Full-Time
Job Type Health Care, Insurance
Education Not Specified
Experience At least 2 year(s)
Manages Others No
Industry Healthcare - Health Services, Insurance
Required Travel Not Specified
Job ID 09A*
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Claims Examiner (Institutional/Hospital)

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