Claims Examiner II
Employment type
Full-time
Work setting
On-site
Location
Miami, FL
Schedule
Day shift
Posted
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Job overview
The Claims Examiner II role is onsite in Miami, FL. Compensation is not specified. The position supports professional claims processing at DOCTORS HEALTHCARE PLANS, INC. The examiner reviews, researches, analyzes, processes, and adjusts claims, applying appropriate benefits and guidelines. The role contributes to accurate claims handling and the team’s quality and production goals through clear internal communication and continued learning about system updates.
What you'll do
- Review, research, analyze, and process professional claims using multiple applications and platforms
- apply appropriate benefits using tools such as CMS guidelines
- communicate clearly with internal departments
- keep current through training on system updates and new applications
- and meet established quality and production goals.
What we're looking for
- Skills & competencies
- claims examiner iidoctors healthcare plansmiami flhealth claimsprofessional claimsclaims processingmedicare advantagecms guidelinesmedical terminologycobmspquality goalsproduction goals
- Work arrangement
- Weekend coverage required
Why this role
The posting seeks 1–3 years of health claims processing experience and knowledge of medical terminology, Medicare Advantage operational and regulatory guidelines, and preferably COB and MSP. High school diploma or GED required.
About the employer
DOCTORS HEALTHCARE PLANS, INC. is hiring for this role. Industry: Direct Health and Medical Insurance Carriers. Sector: 52.
Additional details
- Industry sector
- 52
- Industry
- Direct Health and Medical Insurance Carriers
- Occupation code
- 13-1031.00
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Listing ID: 3c42be22-6dd0-4e7a-92aa-c13f97c6dd3d