Senior Medical Claims Examiner Zodiac Healthcare Irving, TX Job Details Full-time | Contract $20

•$24 an hour 1 hour ago Qualifications Research Refund processing High school diploma or GED Analysis skills Quality assurance Continuous improvement

Full Job Description Role:

Senior Medical Claims Examiner Location:

Irving, TX 75039

Pay Range:

$20

•$24 per hour

Shift:

08:00 AM

•05:00

PM Guaranteed:

40 Hours per

Week Contract Duration:

12

Weeks Job Overview:

We are seeking an experienced Claims Examiner Senior to review, analyze, research, and resolve complex medical claims while ensuring accurate processing and compliance with applicable policies, procedures, and federal regulations. The ideal candidate will have strong experience processing healthcare claims, including CMS-1500 and

CMS-1450/UB-04

claims , and the ability to research claim issues, process adjustments and recoveries, and collaborate with multiple operational departments.

Responsibilities:

Review, analyze, research, and resolve complex medical claims. Process medical claims submitted on CMS-1500 and

CMS-1450/UB-04

forms. Handle claims from physicians, hospitals/facilities, Home Health, DME providers, laboratories, and other healthcare providers. Process claim adjustments, overpayment recoveries, provider refunds, reconsiderations, and direct member reimbursements. Work on claim projects involving overpayments, underpayments, manual processing errors, benefit updates, contract changes, and fee schedule changes. Execute claim batch adjudication and ensure accurate payment resolution. Research and resolve moderately complex claims and escalate issues when appropriate. Ensure claims are processed according to established policies, procedures, processing guidelines, and federal regulations. Assist with database improvements and testing related to system upgrades, conversions, and new processes. Collaborate with Business Configuration, Network Management, Provider Data, Complaints, Appeals & Grievances, and other operational departments. Support claims validation, quality assurance, and process improvement activities.

Required Qualifications:

High School Diploma or equivalent — Required Minimum 3 years of medical claims processing experience in the healthcare industry — Required Experience processing

CMS-1500

claims — Required Experience processing

CMS-1450/UB-04

claims — Required Strong knowledge of medical claims processing, payment resolution, adjustments, and overpayment recovery. Ability to research and resolve complex claims issues. Strong analytical, problem-solving, and communication skills. Ability to work onsite Monday-Friday. #Med1

Pay:

$20.00

•$24.00 per hour Expected hours: 40.0 per week Application Question(s): Do you have hands-on experience processing and adjudicating both CMS-1500 and

CMS-1450/UB-04

claims? Please explain what types of claims you handled. Have you handled complex claims involving overpayments, underpayments, claim adjustments, reconsiderations, provider refunds, or member reimbursements? Please provide an example. Have you worked on the payer/insurance side of claims processing? If yes, which health insurance company/payer and what claims system or platform did you use? Can you provide proof of a High School Diploma or equivalent? Do you have at least 3 years of medical claims processing experience in the healthcare/insurance industry?

Email address:

Availability time for call? Call me at 484 604 8437

Experience:

medical claims processing: 3 years (Required)

Work Location:

In person