Experienced Claims Examiner - Remote

Imagenet LLC is a premier healthcare technology company revolutionizing medical claims processing, document management with unparalleled service, security, and efficiency. Our core mission is to help clients reduce costs and increase productivity by providing streamlined solutions in document imaging, data validation, adjudication, and on-demand retrieval of documents and data.

Job Overview:

As a key member of our claims processing team, you will ensure compliance with all corporate and departmental standards while meeting regularly with employees to discuss performance and quality. You will be responsible for reporting on Key Performance Metrics (KPIs) to the Executive Director of Claims and the Director of Operations to ensure that adequate resources and technology are in place. Additionally, you will develop and implement departmental standards and expectations, while analyzing and processing a variety of claim files to guarantee adherence to standardized claim protocols and proper claim handling.

Job Type: Full-time -

Work Set-up: Remote Position

Pay: $19.00 - $20.00 per hour DOE

Responsibilities:

• Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies.
• Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing.
  
• Process claims end-to-end
  
• Maintain accurate and detailed records of claims processing activities.
  
• Review Medicare services for appropriateness of charges and apply pre-existing guidelines during claims processing.
• Pend claims and order medical records for review and investigation of potential misrepresentation.
  
• Process refunds and letters of dual coverage, when applicable.
• Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues.
  
• Demonstrate proficiency in CPT-4, ICD-9, and ICD-10 coding, as well as medical terminology.
  
• Handle any additional responsibilities as assigned by management.
• Technical Skills/Knowledge
  
• Basic to intermediate math skills.
• Proficiency with MS Office Suite.
• Ability to work independently or as part of a team.

Experience:

• At least 3-5 years of experience in medical claims processing operations, claims adjudication.
• Strong understanding of medical terminology, ICD-10, CPT, and HCPCS coding systems.
• Proficient in health claims processing and adjudication.

What We Offer

• Work/life balance – predictable daytime schedule, no nights
• Paid training to set you up for success
• Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
• Paid Time Off (PTO)
• 7 paid holidays
• A supportive team and a company that values internal growth

Ready to Grow Your Career?

We’d love to meet you! Click “Apply Now” and tell us why you’d be a great addition to the Imagenet team.

About Imagenet, LLC

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers.

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.