Medical Claims Examiner

Summary

Join IMG, a leading international medical insurance company, and become a Claims Examiner. In this role, you will review insurance claims, determine their validity, and conduct necessary investigations. You will resolve medical, dental, life, and trip cancellation claims, ensuring compliance with policies and regulations. Remote and hybrid work schedules are available, along with flexible scheduling after training. Bonus opportunities and a comprehensive benefits package are also offered. The position requires at least one year of medical claims processing experience or related experience, along with knowledge of medical terminology and strong analytical skills. IMG is committed to fostering a diverse and inclusive workplace.

Requirements

• At least 1 year of prior medical claims processing experience OR willing to consider at least 2 years of experience with coding, billing, reviewing medical records, claims research, benefits review, medical office, or any other claims related role (i.e. complex claims, LCM claims, BI claims, P&C claims, etc.)
• Knowledge of basic medical terminology
• Ability to read and interpret insurance policy/certificate wording
• Ability to research and logically consider details from multiple sources to analyze and make a determination of benefits within a productivity-based environment
• Computer skills and proficiency in operating common office equipment
• Documentation, Data Entry Skills
• High attention to detail with ability to analyze information and Problem-solving skills
• Proficiency with basic math

Responsibilities

• Determines covered insurance losses by studying provisions of policy or certificate
• Establishes proof of loss by studying proof of claim; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims
• Documents medical claims actions by completing forms, reports, logs, and records
• Resolves claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter
• Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations
• Maintains quality customer services by following core values

Preferred Qualifications

• Knowledge of ICD-10
• Knowledge of FDA Health and HIPAA Regulations

Benefits

• Quarterly performance bonus (*must meet department standards and qualifications)
• Flexible work schedule
• Comprehensive benefits package including Medical/RX/Dental/Vision insurance
• 401k Plan with company match
• Paid Time Off
• Free employee parking
• Tuition reimbursement plan