Claims Examiner 3 needed to accurately process professional institutional claims. The claims examiner will be responsible for editing and adjusting of claims per the EDI daily audit report, analyze and adjudicate claims to ensure accurate payment. Interpret Fee of Service (FFS) and capitated Provider contracts. Majority of claims will be institutional (UB92 form).

Must have 3-5 years experience as a Medical Claims Examiner

2-3 years experience of institutional claims processing preferred.

Experience in Stop loss, Per Diems and Case Rate processing preferred