Medical Claims Examiner

4 weeks ago


Sacramento, California, United States Benefit & Risk Management Services, Inc. Full time
Job Summary

The Medical Claims Examiner will be responsible for ensuring claims are processed correctly and efficiently. This role requires a strong understanding of employee benefits and the ability to analyze data to determine the validity of claims.

Key Responsibilities:

  • Compare claim data with internal policy and company records to ensure completeness and validity.
  • Adjudicate medical claims and apply coordination of benefits as outlined in plan guidelines.
  • Work with providers to gather necessary documents for final payment determination.
  • Ensure all claims are coded properly.
  • Examine Summary Plan Document and claim adjustors' reports to determine extent of coverage and liability.

Requirements:

  • Associate's degree or equivalent from a two-year college or technical school.
  • 3-5 years of experience in the employee benefits industry.
  • Strong analytical skills and problem-solving abilities.
  • Excellent written and verbal communication skills.
  • Ability to work in a fast-paced environment and meet productivity standards.

About Us:

Benefit & Risk Management Services, Inc. is a leading benefit administrator and healthcare risk manager that delivers innovative technology and administration solutions to control rising healthcare costs.



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