Job Summary
The Sr. Claims Examiner is responsible for analyzing, validating, and processing claims to ensure compliance with plan provisions, regulatory requirements, and internal policies. This role focuses on identifying discrepancies, improving accuracy, and supporting operational efficiency through data-driven insights.
Key Responsibilities
• Review and analyze claims for accuracy, eligibility, and compliance with benefit provisions. • Investigate and resolve discrepancies related to coding, billing, and authorization requirements. • Prepare detailed reports on claims trends and performance metrics. • Collaborate with internal teams to improve claims processes and reduce errors. • Respond to inquiries from providers and members regarding claim status and payment rationale. • Support audits and regulatory reporting as needed.
Required Qualifications
High school diploma or equivalent 1-3 years of experience in claims analysis or healthcare operations Strong knowledge of medical terminology, CPT, HCPCS, ICD-10 codes Proficiency in claims processing systems and Microsoft Excel Excellent analytical, problem-solving, and communication skills Ability to manage multiple priorities in a fast-paced environment
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.