REMOTE OPPORTUNITY: CLAIMS EXAMINER II

We’re seeking a detail-oriented Claims Examiner II to join a progressive Claims Third-Party Administrator (TPA) serving the PACE (Program of All-Inclusive Care for the Elderly) market. This fully remote position offers the chance to work in a collaborative, team-driven environment with strong leadership support designed to set you up for success.
We offer a competitive salary and benefits package, along with flexible working hours to support a healthy work/life balance.

QUALIFICATIONS:

• 3-5 years of experience in a Medicare claims adjudication environment
• Experience in PACE or Medicare Advantage is preferred
• Experience in Plexis Claims Manager is strongly preferred
• Advanced understanding of CMS guidelines
• Strong knowledge of CPT, ICD-10, and HCPCS coding
• Detail-oriented with strong analytical skills
• Ability to work independently
• Effective written and verbal communication skills
• Excellent organizational and time management skills
• Proficient in Microsoft Office Suite (Outlook, Word, and Excel)
  Job Type: Full-time
  Pay: $46,000.00 - $52,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Vision insurance

Work Location: Remot

Reporting to the Claims Manager, the Claims Analyst will be responsible for reviewing and adjudicating medical claims in accordance with established procedures and CMS guidelines. This role focuses primarily on processing professional and facility claims, ensuring accurate and timely payments.