Senior Medical Claims Examiner

Job overview

The Senior Medical Claims Examiner role is onsite in Irving, TX. The stated pay is $22.25 per hour. The role works with business configuration, network management, provider data, complaints, appeals and grievances, and other operational departments. The examiner reviews and resolves complex medical claims according to processing guidelines and federal regulations. The role supports accurate claims processing through analysis, research, payment resolution, validation, and quality assurance.

What you'll do

• Review, analyze, research, and resolve complex medical claims
• analyze claim information and take appropriate payment-resolution action under policies, procedures, and processing guidelines
• process CMS-1500 and CMS-1450/UB-04 claims from facilities, physicians, home health, durable medical equipment providers, and laboratories
• support validation and quality assurance with operational departments.

What we're looking for

Skills & competencies

senior medical claims examiner

irving tx

macpower digital assets edge

$22.25/hour

medical claims

claims processing

cms-1500

cms-1450

ub-04

medicare

managed care

quality assurance

payment resolution

Work arrangement

• Weekend coverage required

Why this role

Requires an associate’s degree or equivalent job-related experience and at least three years of medical claims processing experience; managed care, Medicare, Medicare Advantage, Health Exchange, and TRICARE experience is highly desirable.

About the employer

Macpower Digital Assets Edge Private Limited is hiring for this role. Industry: Claims Adjusting. Sector: 52.