| Medical Claims Examiner II Job Description |
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| The following is a full job description for Medical Claims Examiner II. Here are the requirements and responsibilities for Medical Claims Examiner II along with statistics. If after reading this page you determine that Medical Claims Examiner II is not the position you are looking for, you may want to try one of these similar titles: Claims Examiner II, Disability Claims Examiner III, Claims Examiner I, Claims Examiner III, Claims Examiner IV, Medical Claims Examiner I, Disability Claims Examiner II, Claims Adjuster II - P&C, Claims Supervisor II |
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| Requirements and Responsibilities For Medical Claims Examiner II |
| Examines and adjudicates medical insurance claims to determine eligibility, coverage, and appropriate reimbursement in accordance with plan provisions. Reviews medical documentation, coding, and billing information to verify accuracy and medical necessity. Assesses benefit plans, fee schedules, and regulatory guidelines to calculate and authorize payments. Investigates discrepancies, coordinates with providers, and resolves coding or billing issues as needed. Documents adjudication decisions and supporting rationale clearly within the claims system. Ensures compliance with company standards, plan policies, and applicable regulatory requirements. Requires a bachelor's degree. Typically reports to a manager. Occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. Typically requires 2-4 years of related experience. |
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| Also referred to as: Medical Claims Reviewer II |
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| Similar Jobs: Claims Examiner II, Disability Claims Examiner III, Claims Examiner I, Claims Examiner III, Claims Examiner IV, Medical Claims Examiner I, Disability Claims Examiner II, Claims Adjuster II - P&C, Claims Supervisor II |
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| Level of Education: Medical Claims Examiner II Salaries with No Diploma, Medical Claims Examiner II Salaries with a High School Diploma or Technical Certificate, Medical Claims Examiner II Salaries with an Associate's Degree, Medical Claims Examiner II Salaries with a Bachelor's Degree, Medical Claims Examiner II Salaries with a Master's Degree or MBA, Medical Claims Examiner II Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Financial Services, Healthcare, Insurance | |
