Senior Examiner, Claims (Remote)-Must reside in Florida

Job Description

• Senior-level remote claims examination role with a requirement to reside in Florida; full-time position.
• Requires at least 2 years of claims experience, preferably in managed care, or an equivalent combination of relevant education and experience.
• Evaluates complex claims for incorrect coding, fraud, abuse, waste, overpayments, and processing errors using standard principles and state-specific regulations.
• Manages claims caseloads, obtains supporting medical records and statements, monitors claimant treatment, documents findings, and recommends investigations, resolutions, and defect-reduction solutions.
• Ensures compliance with state and federal turnaround-time and claims-payment regulations across multiple lines of business; proficiency with Microsoft Office and applicable software is required.