Claims Examiner II/III

Job Description

We are currently seeking a skilled Claims Examiner II/III to join our team at Innovative Management Systems Incorporated. This position requires a deep understanding of Medicare claims processing within a managed care organization, IPA, or health plan environment. Responsibilities include accurately reviewing, researching, and analyzing professional claims for a managed service organization (MSO), making benefit determinations, interpreting fee schedules, and collaborating to resolve claim issues.

Position Specifications

• Non-Exempt, Full-Time position with Benefits
• Schedule: Monday - Friday, 8:30 am - 5:30 pm
• Salary Range: $24-$37 per hour based on experience

Key Duties

• Identify and match authorizations to claims
• Adjudicate claims accurately and efficiently
• Understand and apply Division of Financial Responsibilities
• Resolve claims payment errors and generate reports
• Collaborate with stakeholders for claims resolution

Requirements

• High School diploma with 3+ years of claims processing experience
• Knowledge of Medicare rules, medical terminology, and HCFA forms
• Strong communication, organization, and multitasking skills
• Proficiency in Microsoft Office applications

Compensation

$24-$37 Hourly Wage