Vaco by Highspring · 5 hours ago
Claims Examiner
Brookhaven, GA
Full-time
Onsite
Entry, Mid Level
$55K/yr - $65K/yr
2+ years expVaco Atlanta is hiring a Medicare Supplement Claims Examiner for a growing and established company. This role requires an experienced claims examiner to ensure accurate claims adjudication, protect payment integrity, and help prevent fraud, waste, and abuse.
Staffing & Recruiting
Hiring Manager
Evelyn Miller
Responsibilities
Review and adjudicate Medicare Supplement claims in strict adherence to CMS guidelines
Analyze coverage, medical necessity, and billing accuracy; approve, deny, or request additional information
Identify and investigate potential fraud, waste, or abuse and partner with internal teams on resolution
Ensure payment accuracy and prevent overpayments or errors
Support Customer Service Representatives with guidance on complex claims and appeals
Contribute to process improvements, cost savings, and efficiency initiatives
Qualification
Required
2-4 years of Medicare Supplement claims processing experience
Strong knowledge of Medicare Supplement plans, 837 EDI transactions, DME claims, and CMS regulations
Bachelor's degree in healthcare administration, business, or related field (or equivalent experience)
Exceptional attention to detail, analytical skills, and integrity
Proficiency with claims systems and Microsoft Office
Benefits
Discretionary bonuses
Medical, dental, and vision benefits
401(k) retirement plan
Company
Vaco by Highspring
Vaco is the Talent Solutions division of Highspring, a leading global professional services organization.
5001-10000 employees
Funding
Current Stage
Late StageCompany data provided by crunchbase