What are the responsibilities and job description for the Medical Claims Examiner position at E-Solutions IT Services Private Limited?
Overview
We are seeking a highly skilled and detail-oriented Medical Claims Examiner to join our healthcare administration team. The primary responsibility of this role is to review, process, and adjudicate medical insurance claims to ensure accurate and timely reimbursement for healthcare providers and patients. The ideal candidate will possess a comprehensive understanding of medical billing, coding, and insurance claim processing, with a focus on maintaining compliance with industry standards and guidelines. This position offers an opportunity to contribute to efficient revenue cycle management while supporting the delivery of quality healthcare services.
Duties
- Process, adjudicate, and pay UB-92 and HCFA-1500 claims received from affiliated medical groups and hospitals for HMO patients.
- Report directly to the Claims Manager.
- Identify non-contracted providers for Letter of Agreement consideration.
- Interpret provider contract reimbursement terms (desirable).
- Strong understanding of payment methodologies for Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services.
- Knowledge of compliance issues, timeliness, and payment accuracy guidelines for commercial, senior, and Medi-Cal claims.
- Data entry experience.
- Training and proficiency in basic office automation and managed care computer systems.
MUST HAVE:
- Education Verification: Must be able to provide a copy/picture of a High School Diploma, GED, or higher education degree upon submission.
- Claims Experience: 2 years of dedicated Claims Processing and Reimbursement experience (must be explicitly detailed on your resume).
- Adjudication Expertise: Proven experience with the ADJUDICATION of UB-92 and HCFA-1500 claims.
- Specialized Healthcare Knowledge: Direct, hands-on experience working with DOFR (Division of Financial Responsibility) provisions.
- Claim Types: Demonstrated experience processing laboratory claims.
Shift Timing : 7AM-3:30PM
Weekly schedule: M-F
CH1
Pay: $28.00 - $30.00 per hour
Experience:
- dedicated Claims Processing and Reimbursement : 2 years (Required)
Work Location: In person
Salary : $28 - $30