Examiner, Claims (must reside in Florida)

Job Description

• Supports claims examination by evaluating adjudication for incorrect coding, abuse, fraud, waste, overpayments, and processing errors.
• Manages a claims caseload and procures supporting medical records and statements.
• Recommends claims for further investigation or resolution and identifies pre-payment defects and trends.
• Requires at least 1 year of clerical claims or customer-service experience, preferably in managed care, or an equivalent combination of education and experience.
• Must reside in Florida; health care claims/billing and Medicaid claim-processing experience are preferred.