Claims Examiner II/III

Job Description

We are looking for a Claims Examiner II/III at Innovative Management Systems Incorporated. This position requires in-depth knowledge of Medicare claims processing in managed care organizations, such as MSOs, IPAs, and health plans. The ideal candidate will review, research, and analyze professional claims to make benefit determinations based on established criteria and provider contracts. Duties include adjudicating claims, identifying root causes of issues, resolving inquiries, and collaborating with other departments for successful claim resolutions.

Position Specifications

• Non-Exempt, Full-Time
• Benefits include PTO, 401(k), and more
• Schedule: Monday - Friday, 8:30 am - 5:30 pm
• Salary Range: $24-$37 per hour

Requirements

• High School diploma and 3+ years of claims processing experience in managed care organizations
• Knowledge of Medicare rules and regulations, medical terminology, and HCFA 1500 forms
• Excellent communication, organization, and multitasking skills
• Proficiency in Microsoft Office applications