| Medical Claims Examiner I Job Description |
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| The following is a full job description for Medical Claims Examiner I. Here are the requirements and responsibilities for Medical Claims Examiner I along with statistics. If after reading this page you determine that Medical Claims Examiner I is not the position you are looking for, you may want to try one of these similar titles: Claims Examiner I, Disability Claims Examiner III, Claims Examiner III, Claims Examiner IV, Claims Examiner II, Medical Claims Examiner II, Disability Claims Examiner I, Claims Adjuster I - P&C, Claims Clerk I |
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| Requirements and Responsibilities For Medical Claims Examiner I |
| Examines and adjudicates medical insurance claims to determine eligibility, coverage, and appropriate reimbursement in accordance with plan provisions. Reviews medical documentation, coding, and billing information to verify accuracy and medical necessity. Assesses benefit plans, fee schedules, and regulatory guidelines to calculate and authorize payments. Investigates discrepancies, coordinates with providers, and resolves coding or billing issues as needed. Documents adjudication decisions and supporting rationale clearly within the claims system. Ensures compliance with company standards, plan policies, and applicable regulatory requirements. Requires a bachelor's degree. Typically reports to a manager. Work is closely managed. Works on projects/matters of limited complexity in a support role. Typically requires 0-2 years of related experience. |
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| Also referred to as: Medical Claims Reviewer I |
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| Similar Jobs: Claims Examiner I, Disability Claims Examiner III, Claims Examiner III, Claims Examiner IV, Claims Examiner II, Medical Claims Examiner II, Disability Claims Examiner I, Claims Adjuster I - P&C, Claims Clerk I |
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| Level of Education: Medical Claims Examiner I Salaries with No Diploma, Medical Claims Examiner I Salaries with a High School Diploma or Technical Certificate, Medical Claims Examiner I Salaries with an Associate's Degree, Medical Claims Examiner I Salaries with a Bachelor's Degree, Medical Claims Examiner I Salaries with a Master's Degree or MBA, Medical Claims Examiner I Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Financial Services, Healthcare, Insurance | |
