Spectra360 has a great opportunity available for a Temporary Claims Examiner I!

Employment Duration:

Temporary, expected to continue through the end of the year Pay Rate for

Claims Examiner I:

$20.00

•$23.00/hour (Depending on Experience)

Schedule Training:

Monday

•Friday, 8:00 AM

•5:00 PM for approximately 3 to 6 months . Upon successful completion of training, this position offers the potential for a hybrid work schedule based on performance and business needs. Employees must be flexible to work Monday through Sunday , with shifts scheduled as early as 7:00 AM and as late as 8:00 PM . Team members will have the opportunity to bid on their top three preferred shifts; however, shift preferences are not guaranteed . Position Overview We are seeking detail-oriented professionals with strong analytical skills who thrive in a fast-paced healthcare environment. The Claims Examiner I is responsible for reviewing and adjudicating medical claims accurately and efficiently while ensuring compliance with state regulations, contractual agreements, and company policies. This role requires exceptional attention to detail, critical thinking, and a commitment to quality and customer service. Key Responsibilities Review, analyze, and adjudicate medical claims accurately and within required timelines. Determine appropriate payer responsibility using coding, service areas, contracts, and Division of Financial Responsibility (DoFR) guidelines. Process claim payments, denials, and payment adjustments. Process member reimbursement claims while adhering to regulatory deadlines. Ensure clean, accurate, and timely claim processing that meets departmental productivity and quality standards. Forward misdirected claims to the appropriate payer within required timeframes. Maintain high audit scores and consistently meet accuracy and productivity expectations. Review claims involving ICD, CPT, and Revenue Codes. Perform additional claims-related duties and special projects as assigned. Qualifications High School Diploma or equivalent. Minimum of 1 year of medical claims adjudication experience in the healthcare industry (HMO experience preferred). Working knowledge of ICD, CPT, and Revenue Codes. Experience with Facets software is a plus. Intermediate computer skills, including Microsoft Office applications. Excellent analytical, organizational, and problem-solving abilities. Strong attention to detail with the ability to meet strict deadlines. Excellent written and verbal communication skills. Why Join This Team?

Competitive pay:

$20.00

•$23.00/hour Potential hybrid work opportunity after successful training Stable Monday-Friday training schedule Career growth within a respected healthcare organization Collaborative, team-oriented environment Opportunity to develop specialized healthcare claims experience Qualified applicants with criminal histories will be considered for employment. We may be required by local, State or federal law or regulation to restrict or prohibit the hiring of individuals with certain specified Criminal History for the job position including Department of Transportation, FMCS, client requirements, etc. Additionally, material job duties that criminal history may have a direct, adverse, and negative relationship potentially resulting in the withdrawal of the conditional offer include compliance with or the demonstrated ability to comply with company policies prohibiting theft, harassment, safety, violence in the workplace, business conduct, or conflicts of interest.

INDSAC Pay:

$21.00

•$23.00 per hour Expected hours: 40.0 per week

Work Location:

In person