Claims Examiner - RemoteWe are looking for an experienced Claims Examiner to join our rapidly growing team.As a Claims Examiner, you will be responsible for accurately reviewing, investigating, and processing medical claims and provider dispute requests in accordance with payer guidelines, contractual agreements, regulatory requirements, and internal policies.Responsibilities:Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies.Review and investigate provider dispute requests, appeals, and reconsiderations related to processed medical claims.Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing.Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues.Participate in ongoing training and professional development activities.Maintain accurate and detailed records of claims processing activities.Review claim forms and supporting documentsDetermine eligibility, verify data accuracyRequest additional information when neededProcess claims end-to-endIdentify and escalate complex or unusual claims for further review or investigation.Handle more complex claims with multiple services, providersExperience:At least 1-2 years of experience working closely with healthcare claims or in a claims processing/adjudication environment.Experience processing Provider Dispute Resolution (PDR), appeals, reconsiderations, or claim adjustments is highly preferred.Understanding of health claims processing/adjudicationAbility to perform basic to intermediate mathematical computation routinesMedical terminology strongly preferredUnderstanding of ICD-9 & ICD-10Basic MS office computer skillsAbility to work independently or within a teamTime management skillsWritten and verbal communication skillsAttention to detailMust be able to demonstrate sound decision-making skillsWhat We Offer:Remote work offeredEquipment providedPaid training to set you up for successComprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)Paid Time Off (PTO)7 paid holidaysA supportive team and a company that values internal growthImagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans' members and providers.