Medicaid Claims Examiner II

HealthEdge

. Adjudicate healthcare claims utilizing specific 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, and ICD-10 coding, while ensuring adherence to client guidelines and productivity standards. Capable of mentoring team members and collaborating on process improvement initiatives.

Highest-signal resume keywords

Healthcare Claims Processing ExperienceKnowledge of CPT, HCPCS, and ICD-10Ability to Analyze Claim DataMentoring Junior Team MembersCollaboration on Special Projects

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

Healthcare Claims ProcessingClaim Data AnalysisCPT CodingHCPCS CodingICD-10 CodingUB04 KnowledgeCMS 1500 KnowledgeAuthorization KnowledgeMedical TerminologyBilling and Coding

Soft Skills

Team CollaborationStrong Work EthicAdaptabilitySelf-StarterQuick Learner

Tools & Technologies

Claims Processing System

Industry Keywords

HealthcareClaims AdjudicationProvider DataEnrollmentQuality Audits

About the role

Key responsibilities & impact

Adjudicate healthcare claims utilizing specific policies and procedures
Review data within the claims processing system to determine whether services rendered were appropriate and benefit coverage criteria were met
Review adjudication system edits to determine whether to pay claims and/or line items
Process assigned claims based on 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, and client surge activity
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 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, and ICD-10
Knowledge of UB04 and CMS 1500
Knowledge of 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
Ability to work across multiple time zones in a hybrid or remote work environment
Candidates may be required to undergo 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