Claims Examiner II

HealthEdge

. Adjudicate healthcare claims using specified policies and procedures .

Posted 10/12/2026full-timeRemote • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare claims processing, including knowledge of CPT, HCPCS, ICD-10, and medical terminology. Proven ability to analyze claim data, meet productivity targets, and mentor junior team members while ensuring accuracy and quality in processing.

Highest-signal resume keywords

Healthcare Claims ProcessingCPT CodingICD-10 CodingClaims Data AnalysisTeam Collaboration

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims ProcessingData AnalysisMedical TerminologyCPTHCPCSICD-10UB04CMS 1500Authorization KnowledgeClaims Adjudication

Soft Skills

Team CollaborationStrong Work EthicAdaptabilitySelf-StarterQuick Learner

Industry Keywords

HealthcareClaims ProcessingBillingProvider DataQuality Audits

About the role

Key responsibilities & impact

Adjudicate healthcare claims using specified policies and procedures
Review claims-processing system data to determine whether services were appropriate and benefit coverage criteria were met
Review adjudication system edits and determine whether to pay claims or line items
Process assigned claims according to client-specified guidelines or team-leader direction
Meet productivity targets and financial and procedural accuracy standards
Mentor junior team members
Collaborate on special projects, including process documentation, training, quality audits, client surge activity, and other assigned work
Communicate with management regarding issues and concerns and take preventive measures to ensure processing accuracy and quality
Participate in projects involving provider data, authorizations, enrollment, or other activities

Requirements

What you’ll need

High School degree required
1–3 years healthcare claims processing experience
Solid understanding and ability to analyse claim data
Knowledge of physician practices and hospital coding, billing, and medical terminology
Knowledge of CPT, HCPCS, ICD-10, UB04, CMS 1500, and authorizations
ICD-10, CPT, and HCPCS coding is a plus
Willingness to learn new skills
Team collaborator
Strong work ethic
Ability to adapt quickly to a fast-paced environment
Self-starter and quick learner
Ability to collaborate as a team player
Candidates may be required to complete a pre-employment criminal background check

Benefits

Comp & perks

Full-time, permanent employment
Remote work environment
May require travel dependent on company needs
Reasonable accommodations for individuals with disabilities
Equal opportunity employer committed to workforce diversity