Senior Claims Examiner - Philadelphia
6 hours ago
Job description
Job SummaryThe 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.Similar jobs
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