Claims Examiner II

HealthEdge

. Process assigned healthcare claims according to client-specified guidelines or team leader direction .

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, mentor team members, and maintain high productivity and accuracy standards.

Highest-signal resume keywords

Healthcare Claims Processing ExperienceKnowledge of CPT, HCPCS, ICD-10Ability to Analyze Claim DataMentoring Junior Team MembersTeam Collaboration

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Healthcare Claims ProcessingCPT CodingHCPCS CodingICD-10 CodingClaim Data AnalysisMedical TerminologyBilling KnowledgeAdjudication System EditsProvider Data ManagementAuthorization Knowledge

Soft Skills

Strong Work EthicTeam PlayerAdaptabilitySelf-StarterCollaboration

Industry Keywords

Claims Processing SystemFinancial Accuracy StandardsProcedural Accuracy StandardsQuality AuditsSurge Activity SupportPre-Employment Background CheckMultiple Time Zones

About the role

Key responsibilities & impact

Process assigned healthcare claims according to client-specified guidelines or team leader direction
Meet productivity targets and financial and procedural accuracy standards
Review claims processing system data to determine whether services were appropriate and benefit coverage criteria were met
Review adjudication system edits to determine whether claims or line items should be paid
Mentor junior team members
Collaborate on special projects, including process documentation, training, quality audits, and surge activity support
Maintain communication with management to address issues and ensure processing accuracy and quality
Participate in projects involving provider data, authorizations, enrollment, and other assigned 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
Team player with an ability to collaborate
Candidates may be required to go through a pre-employment criminal background check
Ability to work across multiple time zones
Ability to meet the physical demands of prolonged computer-based work, including sitting and/or standing and required vision capabilities

Benefits

Comp & perks

Full-time, permanent employment
Remote work environment
Hybrid or remote work environment
May require travel dependent on company needs
Reasonable accommodations for individuals with disabilities in compliance with the Americans with Disabilities Act of 1990
Equal opportunity employment and workforce diversity commitment