Claims Examiner Contractor
Smart Data Solutions, a leading provider of data management, claim routing and workflow solutions to health plans and TPAs, is looking for a Claims Examiner Contractor to join our team!
What you’ll be doing?
Claim Examiner Responsibilities
- Identify, research, process and resolve claims according to desk level procedures (DLP), business guidelines, and quality standards.
- Meet established productivity and timeliness standards to achieve individual and departmental performance goals as defined.
- Capable of investigative and analytical research, demonstrating critical thinking and deductive reasoning
- Consult and coordinate with various teams/departments to obtain information to ensure proper and timely resolution of claims.
- Demonstrate a high level of flexibility and adaptability; remain available to transition to different work groups based on business need.
- Employs strong organizational skills, makes good use of work time, and demonstrates an ability to effectively use all available resources to meet established claims processing goals.
- Demonstrate and maintain current working knowledge of the client’s systems, procedures, forms, and manuals as applicable.
- Experience with multi-tasking and prioritizing.
- The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
- Adhere to all corporate and client mandatory trainings, privacy and security protocols, time entry requirements, attendance and leave time policies and guidelines.
- Participate in departmental training and calibration meetings as needed.
- Establish and maintain working relationships in a collaborative team environment.
- Exhibit proactive approach by continuously reviewing personal and teamwork processes and sharing suggestions for improvements.
- Identify and support automation opportunities within assigned project work.
- Accurately document your time and the number of records processed daily.
- Perform other duties as assigned.
The duties set forth above are essential job functions for the role. Reasonable accommodations may be made to enable individuals with disabilities to perform essential job functions.
What we’re looking for?
Required skills:
Claim Examiner Skills and Qualifications
- Minimum: High School Diploma or equivalent
- Experience using computer equipment such as laptops, monitors and routers.
- Intermediate level experience with MS Office products.
- Proficiency with Ten Key and Typing skills.
- Ability to read and interpret Standard Operating Procedure documents and performance / production reporting.
- Minimum of 1 year experience adjudicating claims and releasing for payment.
- Familiarity with medical claim forms CMS1500 and UB04
- Knowledge and experience with Medical Code sets ICD 10, HCPCS, CPT and Modifiers
- Conceptual knowledge of coordination of benefits, member/provider claim appeals, government programs (Medicare/Medicaid)
- Ability to maintain confidentiality and privacy.
Preferred candidates possess:
Claim Examiner Contractors
- 3 years of experience in Health Care claim operations
- Organizational skills and experience prioritizing project work and tasks.
- Experience in the health care industry working with Health Plans or Third-Party Administrators.
- Experience working in a remote environment.
Why this is the company for you?
Top Benefits & Perks:
- A company culture that is authentic, innovative, and collaborative! Our most powerful strength is our people! We build impactful solutions for our customers - their success is our success!
- A professional development and growth-oriented workplace
- Generous benefits including, health insurance, short-term, and long-term disability
- 401(k) with a company match to provide a better future in your retirement years
- A flexible environment with a competitive paid time off package; including vacation, holiday, give-back day, and a floating day
Who is Smart Data Solutions?
Smart Data Solutions (SDS) is a technology leader in healthcare process automation and interoperability. As a strategic partner, SDS helps clients digitally transform their operations, delivering tangible value through reduced costs, streamlined workflows, and an improved customer experience. With data, AI, and automation at its core, SDS provides solutions in Digital Mailroom and Data Capture, Clearinghouse, Intelligent Medical Records, Prior Authorization and Claim Operations. Trusted by over 500 clients—including multiple Blue Cross Blue Shield plans, regional health plans, TPAs, providers, and healthcare partners—SDS streamlines complex front, middle, and back-office operations.
Smart Data Solutions is an equal opportunity employer.
All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or other legally protected status.
