Job Description
Hybrid/ Full Time (Must be able to go onsite for training the first two weeks)
A national healthcare consulting and claims administration organization is adding a Medical Claims Examiner due to continued growth and increased client volume.
On a daily basis, you will review professional and facility medical claims for accuracy, medical necessity, and policy alignment. You’ll interpret clinical documentation and coding to determine appropriate payment outcomes, identify discrepancies or potential overbilling, and communicate decisions to providers and internal partners.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.
Required Skills & Experience
2+ years of hands-on medical claims examination or healthcare billing experience
Strong working knowledge of ICD‑10, CPT, and HCPCS coding
Experience reviewing medical records and determining medical necessity
Familiarity with payer policies, benefit plans, and reimbursement methodologies
Ability to clearly document and communicate claim decisions
Comfortable working in claims systems and Microsoft Office
Nice to Have Skills & Experience
CPC, CPMA, CCS, or similar certification
Experience with claim audits, appeals, or complex claim reviews
Exposure to CMS guidelines or regulatory-driven claims environments
Prior work in a consulting, TPA, or managed care setting
Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.