Claims Examiner

Apex Systems
San antonio, TX
30 Sep 2024

Vacancy expired!

Job#: 1293009

Job Description: This job includes claim processing and adjudication, with claims research where applicable. Incumbents must meet and/or exceed qualitative and quantitative production standards. Claims processing may range in level of complexity.

If interested please send your resume to Linda at

Essential Functions:

The essential functions listed represent the major duties of this role, additional duties may be assigned.
  • Day-to-day processing of claims for accounts:
    • responsible for processing of claims (medical, dental, vision, and mental health claims)
    • claims processing and adjudication
    • claims research where applicable.
    • Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic).
    • Incumbents are expected to meet and/or exceed qualitative and quantitative production standards.
  • Investigation and overpayment administration:
    • Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers.
    • Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records.
    • Utilize systems to track complaints and resolutions.
  • Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading.
Experience Required:
  • 3+ years related work experience - Claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry
Education Level:
  • High school diploma or GED
Additional Required Qualifications:
  • Knowledge of CPT and ICD-9 coding required.
  • Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits required.
  • Must possess proven judgment, decision-making skills and the ability to analyze.
  • Must learn quickly as well as be able to multi-task.
  • Must be motivated and possess a sound work ethic.
  • Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers.
  • Concise written and verbal communication skills required, including the ability to handle conflict.
  • Proficiency using Microsoft Windows and Word, Excel and customized programs for medical CPT coding
  • Review of multiple surgical procedures and establishment of reasonable and customary fees.
If interested please send your resume to Linda at

EEO Employer

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at or
  • ID: #46114829
  • State: Texas San antonio 78202 San antonio USA
  • City: San antonio
  • Salary: USD TBD TBD
  • Job type: Permanent
  • Showed: 2022-09-30
  • Deadline: 2022-11-27
  • Category: Et cetera