Claims Examiner I
Rosemont, IL, 60018
Title: Claims Examiner I
Employment Type: Contract
Duration: 4–6 months initially
Location: 100% Remote
Pay Rate: $20-$24 per hour
Target Start Date: November 30, 2026
Benefits: Eligible for Health, Dental, Vision, 401K
Must be authorized to work in the U.S. This position is not eligible for sponsorship.
Position Overview
We are seeking a Claims Examiner I to review, analyze, and process medical claims to determine appropriate payment or denial. The ideal candidate will have hands-on claims processing experience, HMO experience, and knowledge of commercial, Medicare, and Medicaid health plans.
Key Responsibilities
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Review and process medical claims to determine appropriate payment or denial.
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Verify claim accuracy, payment amounts, and required authorizations.
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Research and resolve claims with system errors or payment holds.
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Identify recurring provider and member issues and recommend solutions.
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Coordinate payments between insurance companies when applicable.
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Research and resolve claims-related questions and issues.
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Identify opportunities to improve claims processing workflows.
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Maintain accurate procedures and documentation.
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Follow HIPAA guidelines and protect confidential patient information.
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Work collaboratively with team members and management to meet department goals.
Required Qualifications
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Associate's degree or equivalent experience.
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2–3 years of relevant professional experience, including hands-on claims processing.
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Previous HMO experience.
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Experience processing medical claims.
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Knowledge of Commercial, Medicare, and Medicaid health plans or TPA organizations.
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Strong attention to detail and accuracy.
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Excellent organizational, analytical, and communication skills.
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Proficiency in Microsoft Office and ability to learn new software systems.
Preferred Qualifications
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Knowledge of CPT-4, HCPCS, and ICD-10 coding.
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Familiarity with medical terminology.
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Understanding of medical billing, provider networks, and contracted rates.
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Experience with claims authorizations and coordination of benefits (COB).
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