{"id":20515,"date":"2026-02-26T18:10:07","date_gmt":"2026-02-26T18:10:07","guid":{"rendered":"https:\/\/www.monmouth.edu\/career-development\/job\/claims-examiner-i-entry-level\/"},"modified":"2026-06-25T11:49:08","modified_gmt":"2026-06-25T15:49:08","slug":"claims-examiner-i-entry-level","status":"publish","type":"ch_job","link":"https:\/\/www.monmouth.edu\/career-development\/job\/claims-examiner-i-entry-level\/","title":{"rendered":"Claims Examiner I, Entry Level"},"content":{"rendered":"<p><strong>Job Description<\/strong>:<\/p>\n<p>Claims Examiner will be responsible for adjudicating complex claims, manually and\/or automatically price claims accurately, and identify billing issues.<\/p>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Responsibilities include, but not limited to:<\/p>\n<ul>\n<li>Analyze, research, and process and\/or adjust claims with accurate use of procedures and ICD-10 codes under respective provider and member benefits based on:<\/li>\n<\/ul>\n<ol>\n<li>\u00a0\u00a0\u00a0Contractual agreement<\/li>\n<li>\u00a0\u00a0\u00a0Health Plan division of financial responsibility<\/li>\n<li>\u00a0\u00a0\u00a0Applicable regulatory legislature<\/li>\n<li>\u00a0\u00a0\u00a0Claims processing guidelines<\/li>\n<\/ol>\n<ul>\n<li>Client group\u2019s and company\u2019s policies and procedures<\/li>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Review and process facility (UB-04) and professional (CMS-1500) claims.<\/li>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Process Medicare member claims based on DMHC and DHS regulatory legislature<\/li>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Respond and resolve providers\u2019 and health plans\u2019 inquires in a timely manner<\/li>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Review services for appropriate charges and apply authorization<\/li>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Monitor aging claims with reports to maintain timeliness<\/li>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Maintain quality and productivity standards<\/li>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Participate in special projects<\/li>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Works closely with Supervisor and reports any issues<\/li>\n<\/ul>\n<p><strong>Qualifications<\/strong>:<\/p>\n<ul>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0At least a high school diploma<\/li>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Applicable healthcare claims adjudication experience within a managed care industry is a plus<\/li>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Familiar with ICD-10, HCPCS, CPT coding, APC, ASC, and DRG pricing<\/li>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Familiar with facility and professional claim billing practices<\/li>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Must have good written and communication skills.<\/li>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Must be able to follow guidelines, multi-task, and work comfortably within a team-oriented environment.<\/li>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Computer literacy required, including proficient use of Microsoft Word, Excel, and Outlook. Knowledge in EZ-CAP 6X is a plus.<\/li>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Familiar with SSRS is a plus.<\/li>\n<li>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Typing skills of at least 40 wpm.<\/li>\n<\/ul>\n","protected":false},"featured_media":0,"template":"","meta":{"_ch_employer_id":"20514","_ch_external_id":"10790659","_ch_location_state":"","_ch_location_city":"","_ch_is_ocr_job":"","_ch_expiration_date":"2026-06-27","_ch_apply_link":"https:\/\/monmouth.joinhandshake.com\/jobs\/10790659\/share_preview"},"ch_stakeholder":[],"ch_class_year":[],"ch_job_category":[86],"ch_career_skill":[],"ch_industry":[62],"class_list":["post-20515","ch_job","type-ch_job","status-publish","hentry","ch_job_category-full-time","ch_industry-healthcare-medicine-wellness"],"_links":{"self":[{"href":"https:\/\/www.monmouth.edu\/career-development\/wp-json\/wp\/v2\/ch_job\/20515","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.monmouth.edu\/career-development\/wp-json\/wp\/v2\/ch_job"}],"about":[{"href":"https:\/\/www.monmouth.edu\/career-development\/wp-json\/wp\/v2\/types\/ch_job"}],"wp:attachment":[{"href":"https:\/\/www.monmouth.edu\/career-development\/wp-json\/wp\/v2\/media?parent=20515"}],"wp:term":[{"taxonomy":"ch_stakeholder","embeddable":true,"href":"https:\/\/www.monmouth.edu\/career-development\/wp-json\/wp\/v2\/ch_stakeholder?post=20515"},{"taxonomy":"ch_class_year","embeddable":true,"href":"https:\/\/www.monmouth.edu\/career-development\/wp-json\/wp\/v2\/ch_class_year?post=20515"},{"taxonomy":"ch_job_category","embeddable":true,"href":"https:\/\/www.monmouth.edu\/career-development\/wp-json\/wp\/v2\/ch_job_category?post=20515"},{"taxonomy":"ch_career_skill","embeddable":true,"href":"https:\/\/www.monmouth.edu\/career-development\/wp-json\/wp\/v2\/ch_career_skill?post=20515"},{"taxonomy":"ch_industry","embeddable":true,"href":"https:\/\/www.monmouth.edu\/career-development\/wp-json\/wp\/v2\/ch_industry?post=20515"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}