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AppleOne
Medical Claims Examiner
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Based on Louisiana data
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What they do
A Medical Claims Examiner evaluates medical insurance claims in accordance with applicable contracts and government regulations. Verifies that medical treatment costs are accurate given a patient's diagnosis. May specialize in specific types of treatments or types of drug claims.
$51,920 / year median in Louisiana
+6% projected growth
Job Description
Job Summary A temp-to-hire opportunity is available for a Medical Claims Examiner in Bossier City, LA. This role is ideal for a detail-oriented claims professional with experience reviewing medical, dental, and short-term disability claims in a healthcare services environment. The Medical Claims Examiner will verify claim information, review medical necessity, apply plan benefits, and determine whether claims should be authorized, denied, or sent for additional information. This position offers a Monday through Friday schedule, healthcare options, PTO, and the opportunity to grow with a supportive team that values accuracy, collaboration, sound judgment, and consistent performance. Key Responsibilities
- Review medical, dental, and short-term disability claims for accuracy, completeness, and benefit eligibility.
- Analyze diagnosis codes, procedure codes, plan documents, and submitted medical information to determine claim payment status.
- Process primary and secondary claims, including coordination of benefits determinations.
- Authorize, deny, or request additional documentation for claims based on plan guidelines and claim details.
- Communicate with group contacts, providers, and patients by phone or written correspondence as needed.
- Maintain a high level of claims processing accuracy, with a goal of 95% or greater accuracy. Compensation and Benefits
- Pay range: $14 to $17.
Schedule:
Monday through Friday.- Job type: Temp-to-hire.
Benefits:
Healthcare options and PTO. Required Qualifications and Skills- Verify claim data and supporting documentation for medical, dental, and short-term disability claims.
- Analyze claims for payment eligibility, medical necessity, coordination of benefits, and plan compliance.
- Read and interpret plan documents to determine correct benefits and adjudication outcomes.
- Communicate with providers, patients, and group contacts to obtain information needed to process claims.
- 1 to 2 years of medical claims experience preferred or required based on role needs.
- Familiarity with ICD-10 diagnosis codes, HCPCS codes, CPT procedure codes, and medical and dental terminology.
- Ability to review medical information and make sound claim payment decisions.
- Strong accuracy, attention to detail, and commitment to quality performance.
- Computer proficiency and ability to learn claims systems quickly.
- Strong reasoning, judgment, communication, and problem-solving skills.
- Team-oriented work style with a commitment to excellence. Preferred Qualifications
- Prior Third Party Administrator, TPA, experience.
- Experience working with the LuminX, EBIX, claims adjudication system.
- Experience processing secondary claims and coordination of benefits.
- Previous experience reviewing medical necessity and claim payment eligibility.