HealthEZ · 1 month ago
Claims Examiner
Bloomington, MN
Full-time
Onsite
Mid, Senior Level
$23/hr - $27/hr
5+ years expHealthEZ is seeking a highly motivated Claims Examiner who combines exceptional analytical and problem-solving skills. The role involves adjudicating medical and dental claims in accordance with company policies and maintaining accurate claim records.
Health CareInsurance
Responsibilities
Adjudicate medical and dental claims accurately and timely by applying company policies and the Plan summary of benefits
Examine claims, identifying duplicates, mispriced or miscoded claims, etc
Examine claims and adjudicate according to Plan Summary Documentation (SPD) and other claims adjudication rules such as coordination of benefit (COB), code editing and payment integrity claims rules
When necessary, reprice claims, using the network's proprietary portal
Enter manual claims received from Members or Providers
Other duties as assigned
Qualification
Required
High School diploma or equivalent
Experience interpreting Summary Plan Documents (SPD)
Familiarity with CPT, ICD10, & HCPCS codes
Self-Starter and ability to work independently
Highly collaborative and able to function well in a team environment
Highly organized with great attention to detail
Ability to learn new systems efficiently & effectively
Preferred
5 years of claims processing experience in a TPA setting
Experience with Plan Summary documentation for Health plans
VBA experience or similar claims systems experience
Benefits
Health benefits
Retirement plan (401k)
Paid time away
Paid leaves (including paid parental leave)
Company
HealthEZ
HealthEZ is an independent third-party administrator of employer-sponsored, self-funded medical plans.
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2020-07-07Acquired
Leadership Team
Catherine Vanden Plas
Chief Operating Officer
Jim Wachtel MBA
Chief Revenue Officer (CRO)
Recent News
2025-11-04
2023-06-07
Company data provided by crunchbase