Claims Examiner - Remote

Claims Examiner - Remote

Job Type:Full-time 

Work Setup: This is a fully remote position
Work Hours: Pacific Time Zone 

We are looking for Experienced  Claims Examiner to join our rapidly growing team.

Experience is required for this position.

Job Overview:

As aClaims Examiner, you will be responsible for accurately reviewing, investigating, and processing medical claims and provider dispute requests in accordance with payer guidelines, contractual agreements, regulatory requirements, and internal policies.

Responsibilities:

• Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies.
• Review and investigate provider dispute requests, appeals, and reconsiderations related to processed medical claims.
• Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing.
• Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues.
• Participate in ongoing training and professional development activities.
• Maintain accurate and detailed records of claims processing activities.
• Review claim forms and supporting documents
• Determine eligibility, verify data accuracy
• Request additional information when needed
• Process claims end-to-end
• Identify and escalate complex or unusual claims for further review or investigation.
• Participate in ongoing training and professional development activities.
• Handle more complex claims with multiple services, providers

Experience:

• At least1-2 years of experience working closely with healthcare claims or in a claims processing/adjudication environment.
• Experience processing Provider Dispute Resolution (PDR), appeals, reconsiderations, or claim adjustments is highly preferred.
• Understanding of health claims processing/adjudication
• Ability to perform basic to intermediate mathematical computation routines
• Medical terminology strongly preferred
• Understanding of ICD-9 & ICD-10
• Basic MS office computer skills
• Ability to work independently or within a team
• Time management skills
• Written and verbal communication skills
• Attention to detail
• Must be able to demonstrate sound decision-making skills

What We Offer

• Remote work offered
• Equipment provided
• Paid training to set you up for success
• Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
• Paid Time Off (PTO)
• 7 paid holidays
• A supportive team and a company that values internal growth

Ready to Grow Your Career?

We’d love to meet you! Click “Apply Now” and tell us why you’d be a great addition to the Imagenet team.

About Imagenet

Imagenet is a technology-forward healthcare operations partner with more than 25 years of experience helping healthcare payers manage critical administrative and operational processes. Founded in 2000 and headquartered in Tampa, Florida, Imagenet supports 150+ health plans through its payer clients.

Our teams help improve efficiency, accuracy, visibility, and service across complex healthcare operations, including digital mailroom, claims adjudication, contact center, member communications, and related administrative functions. By combining experienced operational teams, proven processes, and purpose-built workflow technology, Imagenet helps payers keep essential processes moving for the members, providers, and communities they serve.

Imagenet operates 10 secure facilities across the U.S. and one secure facility in Manila, Philippines.

Joining Imagenet means contributing to work that supports the healthcare operations members and providers rely on every day.