Claims Examiner

This job was posted by https://www.kansasworks.com : For more

information, please see: https://www.kansasworks.com/jobs/13531719 **Are

you ready to make a difference? Choose to work for one of the most

trusted companies in Kansas.**

You Belong At Blue

• Why Join Us?**
• **Make a Positive Impact:** Your work will directly contribute to
  
  

the health and well-being of Kansans.

• **Family** **Comes First**: Total rewards package that promotes the
  
  

idea of family first for all employees. Paid vacation and sick leave

with paid maternity and paternity available immediately upon hire

• **Professional Growth Opportunities:** Advance your career with
  
  

ongoing training and development programs.

• **Dynamic Work Environment:** Collaborate with a team of passionate
  
  

and driven individuals in a work environment that promotes

flexibility.

• **Trust and Stability:** Work for one of the most trusted companies
  
  

in Kansas with over 80 years of commitment, compassion and

community.

• **Inclusive Work Environment:** We pride ourselves on fostering a
  
  

workplace where everyone is valued and respected.

**Benefits & Perks**

• Base compensation is only one component of your competitive Total
  
  

Rewards package

• Incentive pay program (EPIP)
• Health/Vision/Dental insurance
• 6 weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks paid caregiver leave
• 401(k) plan matching up to 5%
• Tuition reimbursement
• Health & fitness benefits, discounts and resources
  
  

**Job Summary**

A health claims examiner is responsible for reviewing, evaluating, and

processing health, drug, dental and/or ancillary product claims

submitted by members or providers for insurance reimbursement. The job

involves ensuring that claims are processed accurately and timely, in

accordance with policy terms, industry regulations, and company

guidelines.

This pool will start training on May 26, 2026

\"This position is eligible to work remotely or onsite in accordance

with our Telecommuting Policy. Applicants must reside in Kansas or

Missouri or be willing to relocate as a condition of employment.\"

**What you\'ll do**

• **Claims review and verification**
• Accurately review, analyze, and verify healthcare claims
  
  

submitted by policyholders or medical providers.

• Ensure all necessary documentation, coding (International
  
  

Classification of Diseases, Tenth Revision (ICD-10), Current

Procedural Terminology (CPT), Healthcare Common Procedure Coding

System (HCPCS)), and data are included and correct.

• Check for eligibility, coverage, and applicable benefits as per
  
  

policy terms.

• **Claims Processing**:
• Enter and process claims information into the system with
  
  

precision and attention to detail.

• Apply appropriate insurance guidelines, including deductibles,
  
  

co-pays, co-insurance, and maximum coverage limits.

• Approve or deny claims based on policy coverage, ensuring
  
  

compliance with regulatory and company standards.

• Perform adjustments to processed claims as needed for corrective
  
  

action.

• **Communication**:
• Correspond with healthcare providers, patients, and internal
  
  

departments to clarify or resolve discrepancies.

• **Problem Resolution**:
• Investigate and resolve complex or escalated claim issues, such
  
  

as coding errors, benefit misunderstandings, or billing

discrepancies.

• **Compliance and Documentation**:
• Ensure compliance with state and federal healthcare regulations.
• Maintain detailed and accurate records of all claims processed,
  
  

including documentation for audits or reviews.

• **Efficiency and Quality**:
• Meet individual and team pe formance targets related to claims
  
  

processing speed, accuracy, and quality.

• Participate in ongoing training to stay updated on changes in
  
  

health insurance policies and claims processing technologies.

• Monitor and work daily reports to ensure timely claim control.
  
  

**What you need**

**Knowledge/Skills/Abilities**

• Strong attention to detail and organizational skills.
• Knowledge of medical claim processing, medical terminology,
  
  

insurance policies, and coding standards (ICD, CPT).

• Excellent communication skills, both written and verbal.
• Ability to work efficiently under pressure and meet deadlines.
• Critical thinking and problem solving skills
• Office and/or computer system experience preferred
  
  

Education And Experience

• High school diploma or equivalent required
• Previous experience in healthcare claims processing, medical
  
  

billing, medical terminology, or health insurance is preferred.

**Physical Requirements**

Office setting, with remote or hybrid work opportunities depending