The Claim Examiner will review and process healthcare claims, ensuring compliance with policies and regulatory requirements while assessing medical necessity and resolving discrepancies.
Role: Claim Examiner // EZCAP Examiner
Hiring mode: Contract
Location: California, United States (Remote)
Work time zone: PST
Must have Skills:
- EZ-CAP 5-6 years
- Medi-Cal (California Medicaid) experience
Role and Responsibilities:
- Review, process, and adjudicate high-complexity healthcare claims in compliance with company policies, contractual provisions, and regulatory requirements.
- Ensure accurate application of CPT, ICD-10, HCPCS, and other relevant codes.
- Validate and cross-check information on claim forms, ensuring completeness and accuracy.
- Assess medical necessity, coverage eligibility, and appropriateness of services provided.
- Investigate and resolve complex claim discrepancies and issues.
Here at Emids we're not scared of differences. It's how we break new ground. As we scale and elevate the experience of our clients in the Healthcare & LifeSciences Space and ultimately have an impact on every patient from every walk of life, the team we build must be reflective of the diversity that we serve. Together, we've built and will continue to grow, a diverse and inclusive culture where everyone has a seat at the table and the space to be their most authentic self. Emids believes in being an Equal Opportunity Employer and we support, celebrate, and cherish all the things that make our teammates who they are.
Top Skills
Ez-Cap
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