Institutional Claims Examiner I

We’re looking for a detail oriented Institutional Claims Examiner to join our team and ensure the accurate and compliant processing of institutional healthcare claims across all lines of business. This role is responsible for adjudicating claims, verifying medical and billing accuracy, and ensuring compliance with CMS, DMHC, DHS, and network policies.

The ideal candidate will demonstrate strong analytical skills, proficiency in CPT, ICD-10, Revenue, Bill Type, and HCPCS coding, and a commitment to maintaining data integrity and timely payment resolution. This position plays a key role in supporting provider relations, preventing discrepancies, and upholding the highest standards of accuracy and compliance in claims processing.