Medicaid Claims Examiner II

HealthEdge

. Adjudicate healthcare claims using specified policies and procedures .

Posted 10/8/2026full-timeRemote • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

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

Highest-signal resume keywords

Healthcare Claims Processing ExperienceKnowledge of CPT, HCPCS, ICD-10Claims Data AnalysisTeam Collaboration AbilityMentoring Junior Team Members

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationClaims Processing System Data ReviewMedical TerminologyCPT CodingHCPCS CodingICD-10 CodingUB04CMS 1500Claims Data AnalysisProvider Data Management

Soft Skills

Strong Work EthicAdaptabilityTeam PlayerSelf-StarterQuick Learner

Industry Keywords

Healthcare ClaimsBenefit Coverage CriteriaQuality AuditsProcess DocumentationClient-Specific Guidelines

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 to determine whether claims or line items should be paid
Process assigned claims according to client-specific 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, and surge support for clients
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, and 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 collaboration ability
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
Work across multiple time zones
May require travel dependent on company needs
Reasonable accommodations for individuals with disabilities in compliance with the Americans with Disabilities Act of 1990