Claims Examiner

Join a healthcare organization dedicated to operational excellence and accurate claims processing. This role is essential in ensuring timely and precise adjudication of provider claims while maintaining compliance with healthcare guidelines and policies. Responsibilities: Process medical and surgical claims, ensuring complete and accurate member and provider information Adjudicate claims within established guidelines and authorize final claim disposition Apply administrative policies and claims processing procedures as needed Review claims for accuracy, validity of charges, and potential errors Evaluate pended claims related to contractual or payment discrepancies Generate correspondence to providers requesting additional information when necessary Maintain productivity and quality standards established by the department Update reference materials and participate in training sessions Track individual production metrics and performance goals Perform additional duties and support functions as assigned Qualifications: Associate degree or equivalent combination of education and experience Minimum 2 years of experience in the healthcare insurance industry Knowledge of integrated claims processing systems Strong data entry skills with high attention to detail Knowledge of medical terminology, CPT, ICD codes, and revenue codes Ability to work efficiently in a fast-paced environment Strong organizational and communication skills Please note that the salary range and/or hourly rate range of $25.00 - $30.00 is a good faith determination of potential base compensation offered to applicants at the time of this job advertisement and may be subject to modification in the future. When determining a team member's base salary and/or hourly rate, various factors may be taken into account as applicable (such as location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget, and internal equity). For consideration to this and/or other roles suitable for your background, please submit your most up-to-date resume to join our talent pool. At ATRIA Consulting, LLC, we are a woman-owned business fully committed to promoting, cultivating, and maintaining a culture of diversity, equity, and inclusion. We embrace and celebrate differences across all demographics and backgrounds. We encourage everyone to apply.