Claims Examiner

• Medical Insurance EMI Health
• 3.2 Murray, UT Job Details Full-time 19 hours ago Benefits Vision insurance Opportunities for advancement Qualifications Decision making Full Job Description Medical Insurance Claims Examiner Murray, UT | Full-Time | Monday-Friday, 8:00 AM
• 5:00 PM In-Office Position, Hybrid after probationary period, Must reside in Utah Have a sharp eye for detail and a strong grasp of insurance claims processes? Join our team as a Medical Insurance Claims Examiner, where you will play a key role in ensuring our members receive accurate and timely decisions on their insurance claims. What You'll Do Claims Processing
• Resolve exceptions and pending items for medical and vision claims, accurately determining claim status (approve, pend, or deny). Document Review
• Examine electronic and paper claim forms for completeness and accuracy. Claims Analysis
• Evaluate claim details to understand the nature of a member's illness or injury. Coverage Determination
• Analyze coverage and apply EMI Health's guidelines and procedures to ensure claims are processed accurately. Decision Making
• Use sound judgment within policy guidelines to approve, pend, request additional information, or deny claims. Team Collaboration
• Work closely with peers to support department and organizational goals. Continuous Learning
• Stay updated by participating in training sessions and department meetings. What We're Looking For Education
• High school diploma or GED required; or two or more years of relevant experience or training; or an equivalent combination of both. Knowledge
• General understanding of medical terminology, coding, and health insurance benefit plans. Preferred Expertise
• Familiarity with Medicare Secondary Payer and Coordination of Benefits (COB) rules is a plus. Why You'll Love It Here Impact
• Play a vital role in ensuring our members receive the benefits they deserve. Growth
• Opportunities for professional development and career advancement. Team Environment
• Collaborate with a dedicated and supportive team committed to excellence.

EMI Health is proud to be an Equal Employment Opportunity (EEO) employer.