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Medical Claims Examiner

International Medical Group is now hiring for medical Claims Examiners!

Job Summary

Claims Examiners provide a service to our policyholders by reviewing claims to determine the validity of the insurance claim filed and identify the need for further investigations.  Examiners resolve medical/dental/life/trip cancellation claims; document actions; maintain their imaging queues; maintain quality audit standards, and ensure their outcomes are in compliance with the Certificate of Insurance, Policy and Plan Documents, as well as legal and regulatory agencies.

Duties and Responsibilities:

  • Determines covered insurance losses by studying provisions of policy or certificate.
  • Establishes proof of loss by studying proof of claim; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims.
  • Documents medical claims actions by completing forms, reports, logs, and records.
  • Resolves claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter.
  • Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.
  • Maintains quality customer services by following core values.

Qualifications:

  • Prior medical claims examining experience - minimum three years of work experience preferred
  • Knowledge of ICD-9 and ICD-10
  • Strong computer skills and proficiency in operating common office equipment
  • Documentation skills, data entry skills, analyzing information, and problem solving
  • FDA Health and HIPAA Regulations, Statistical Analysis
  • Basic math skills preferred

Perks:

  • Comprehensive benefits package including Medical/Dental/RX/Vision insurance
  • 401k Plan with company match
  • Short and Long term Disability
  • Tuition reimbursement plan
  • Casual dress environment
  • On site fitness center

For more than 25 years, International Medical Group® (IMG®) has provided global benefits and assistance services to millions of travelers in almost every country. Our comprehensive range of international medical and travel insurance products ensures our members are covered wherever they may go. However, IMG provides more than just insurance; we provide the Global Peace of Mind® you deserve, backed by a team of internationally based professionals committed to serving you 24/7.  

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