Medical Claims Examiner

1 week ago


Aurora, Colorado, United States UNITE HERE HEALTH Full time

UNITE HERE HEALTH is a leading provider of healthcare benefits to workers and their families in the hospitality and gaming industry. Our innovative approach to healthcare drives us to develop impactful programs and benefits that engage participants in managing their own health and healthcare. We are seeking a Claims Adjudicator I to join our team in a fully remote position. The successful candidate will be responsible for receiving, examining, verifying, and inputting submitted claim data, determining eligibility status, and reviewing and adjudicating claims within established timeframes. This role utilizes multiple systems to perform day-to-day functions of processing medical, disability, vision, and dental claims, as well as provider and member-driven inquiries. Key responsibilities include screening claims for completeness, verifying participant eligibility, interpreting plan benefits, coding basic information, evaluating diagnoses and procedures, and determining payment liability amounts. The ideal candidate will have 2-3 years of related experience in medical claim adjudication, working knowledge of benefit plans, and experience with eligibility verification, medical coding, and coordination of benefits. We offer a competitive hourly rate, a comprehensive benefits package, and opportunities for professional growth and development. If you are a motivated and detail-oriented individual with a passion for healthcare, we encourage you to apply for this exciting opportunity.



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