Claims Examiner – Healthcare Claims Processing (UB-04 & CMS-1500)Sigma Inc. is seeking a detail-oriented Claims Examiner to join our healthcare operations team in Irving, TX. This is an excellent opportunity for professionals with experience in healthcare claims processing, medical claims adjudication, data entry, and HIPAA-compliant environments.The ideal candidate will have experience reviewing and processing UB-04 and CMS-1500 claims, resolving claim issues, maintaining high accuracy standards, and working collaboratively with healthcare providers and internal departments.Key ResponsibilitiesProcess and adjudicate healthcare claims, including UB-04 and CMS-1500 claims formsMaintain production standards of approximately 150 claims per dayAchieve and maintain 98% statistical accuracy and 98% financial accuracyPerform claim review, data entry, validation, and issue resolutionResearch and correct DoD error reports as neededRespond to provider, customer service, and claims-related inquiries in a timely mannerCollaborate with Business Configuration, Network Management, Provider Data, Appeals, Grievances, and other operational teamsEnsure compliance with healthcare regulations, policies, and HIPAA requirementsSupport quality assurance initiatives and continuous process improvementsPerform additional duties as assigned by managementRequired QualificationsHigh School Diploma or equivalentExperience processing healthcare claims preferredKnowledge of UB-04 and CMS-1500 claim formsStrong data entry and analytical skillsAbility to maintain productivity and accuracy standardsExcellent attention to detail and organizational skillsStrong written and verbal communication skillsAbility to work independently and in a team-oriented environmentUnderstanding of HIPAA regulations and Protected Health Information (PHI) requirementsPreferred SkillsMedical Claims ProcessingClaims AdjudicationHealthcare AdministrationInsurance Claims ReviewProvider RelationsData EntryClaims ResolutionQuality AssuranceHIPAA ComplianceMedical BillingHealthcare Operations
Claims Examiner Sr in irving at Unknown Company
This position is listed as full time and onsite.