Claims Examiner

Please find below the Job Description:

• Job Title : Claims Examiner/Claims Processor / Claims Adjudicator (Healthcare Insurance)
• Duration : 3-6 months possibility for extension more
• Location : New York NY (Hybrid)
• Pay Rate : $30-$31/Hr.

Job Summary

We are seeking a detail-oriented Claims Processor to review, evaluate, and adjudicate healthcare claims accurately and within defined guidelines. The ideal candidate will have experience in medical claims processing and strong knowledge of coding systems and insurance policies.

Key Responsibilities

• Process and adjudicate medical and surgical claims in a timely manner
• Verify completeness and accuracy of member and provider information
• Apply claims processing guidelines, policies, and procedures
• Identify errors, discrepancies, or invalid charges on claims
• Review and resolve system-pended claims
• Initiate communication with providers to obtain additional information when required
• Meet productivity and quality benchmarks
• Maintain accurate records and participate in training and process updates

Required Qualifications

• Associate’s degree or equivalent combination of education and experience
• Minimum 2 years of experience in healthcare insurance or claims processing
• Strong data entry and analytical skills
• Good understanding of medical terminology, CPT, ICD, and revenue codes

Preferred Skills

• Experience with integrated claims processing systems
• Strong attention to detail and problem-solving ability
• Good communication and organizational skills

Benefits:

Pride Health offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, , legal support, auto ,home insurance, pet insurance, and employee discounts with preferred vendors.