Pay Growth
?
out of 5
Not enough data
Not enough info to score pay or growth
Medical Claims Examiner
Job
Robert Half
Greenville, SC (In Person)
Full-Time
Review key factors to help you decide if the role fits your goals.
Job Security
?
out of 5
Not enough data
Calculating job security score...
Total Score
57
out of 100
Average of individual scores
Skill Insights
Compare your current skills to what this opportunity needs—we'll show you what you already have and what could strengthen your application.
Job Description
We are looking for a detail-focused Medical Claims Examiner to join an insurance organization in Greenville, South Carolina. This position is suited for someone with hands-on experience adjudicating medical claims and applying plan provisions, coding standards, and pricing rules with accuracy. The person in this role will help ensure claims are processed efficiently, in compliance with benefit plans, contractual arrangements, and regulatory requirements.
Responsibilities:
- Review and adjudicate medical, dental, vision, and flexible spending account claims from intake through final payment determination.
- Examine suspended or flagged claims to identify billing discrepancies, duplicate submissions, unbundled charges, or other questionable claim activity.
- Resolve system-related claim exceptions by making manual corrections before claims are finalized for payment.
- Apply member benefits, provider contract terms, fee schedules, and applicable regulations to calculate accurate reimbursement outcomes.
- Interpret coding and billing details, including diagnosis and procedure information, to support proper claim handling.
- Escalate complex claim issues or unclear situations to leadership when additional review or guidance is needed.
- Manage assigned exception reports and follow through on outstanding claim items in a timely manner.
- Meet established productivity, turnaround, and quality expectations while maintaining dependable attendance at the Greenville, South Carolina worksite.