Medicaid and Medicare Claims Examiner II

HealthEdge

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

Posted 10/13/2026full-timeRemote • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare claims processing, including knowledge of CPT, HCPCS, and ICD-10 coding, while maintaining high standards of accuracy and productivity. Proven ability to mentor team members and collaborate on projects to enhance operational efficiency.

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 TerminologyBillingCodingCPTHCPCSICD-10UB04CMS 1500

Soft Skills

MentoringStrong Work EthicAdaptabilityTeam PlayerSelf-Starter

Industry Keywords

HealthcareClaims AdjudicationProvider DataAuthorizationsEnrollment

About the role

Key responsibilities & impact

Process assigned healthcare claims according to client-specified guidelines or team-leader direction
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
Meet productivity targets and financial and procedural accuracy standards
Mentor junior team members
Collaborate on special projects, including process documentation, training, quality audits, and surge activity support
Maintain communication with management regarding issues and concerns
Take preventive measures to ensure processing accuracy and quality
Participate in projects involving provider data, authorizations, enrollment, or 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, authorizations, and healthcare concepts
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