Claims Examiner - Medical Insurance

Medical Insurance Claims Examiner Murray, UT | Full-Time | Monday–Friday, 8:00 AM – 5:00 PM In-Office Position, Hybrid after six month introductory 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. Knowledge – Three to five years of experience processing Medical Claims. Experience with physician and facility claims. Working understanding of medical terminology, coding, and health insurance benefit plans.

Preferred Expertise – Certified Professional Coder (CPC), 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.