Senior Claims Examiner - CornerStone Staffing
Irving, TX
About the Job
Seeking a skilled Senior Claims Examiner – Make an Impact in Healthcare!
Are you a detail-oriented professional with a passion for accuracy and efficiency in medical claims processing? As a Senior Claims Examiner, you’ll play a vital role in ensuring accurate claim resolutions while working in a collaborative and supportive environment. If you’re ready to apply your expertise, problem-solving skills, and industry knowledge to make a difference, apply today and be part of a team that values excellence and innovation in healthcare!
Job Title: Senior Claims Examiner
Location: Irving, TX 75039 | Fully onsite
Pay Range: $22.00-$24.00/hr
Job Type: Full-Time, Long Term Contract
Work Schedule: Monday – Friday | Available to work an 8hr shift between 7am-7pm
Job Summary:
The Senior Claims Examiner is responsible for reviewing, analyzing, and resolving complex medical claims while ensuring compliance with claims processing guidelines and federal regulations. This role collaborates with various internal departments, including Business Configuration, Network Management, Provider Data, Complaints, Appeals and Grievances, to validate and improve claims processing accuracy and efficiency.
Key Responsibilities:
Analyze and process medical claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms from providers, including facilities, physicians, Home Health, Durable Medical Equipment suppliers, and laboratories.
Review and resolve claim overpayments and underpayments, ensuring accurate manual processing, benefit updates, contract adjustments, and fee schedule changes.
Handle provider refunds, reconsiderations, direct member reimbursements, and medical claim adjustments.
Conduct claims batch adjudication and recovery of claim overpayments.
Identify, analyze, and escalate complex claims issues to Claims Team Lead, Supervisor, or Manager as needed.
Assist with system upgrades, database improvements, and testing for new processes.
Train and mentor new and existing associates, providing guidance on updated policies, desktops, and procedures.
Maintain high standards of performance while fostering teamwork and a professional work environment.
Communicate with internal and external stakeholders to resolve claim-related inquiries.
Identify claim trends, gaps in workflow, and contribute to the development of updated policies and procedures.
Organize and prioritize tasks to meet deadlines, demonstrating strong problem-solving and decision-making skills.
Ensure compliance with HIPAA regulations and company guidelines to protect patient information.
Meet and exceed productivity and quality standards while maintaining attention to detail.
Perform additional duties as assigned to support departmental and organizational objectives.
Qualifications:
Associate’s degree or equivalent job-related experience required.
Minimum of 3 years’ experience in medical claims processing within the healthcare industry.
Experience with managed care, Medicare, Medicare Advantage, Health Exchange, and TRICARE is highly desirable.
Strong knowledge of medical terminology, CPT, HCPCS, ICD-10, Revenue Codes, and reimbursement methodologies.
Proficiency in Microsoft Office Suite (Excel, Word, Outlook, PowerPoint) and database management.
Excellent written, verbal, and interpersonal communication skills.
Ability to analyze and interpret complex data with high attention to detail.
Strong organizational skills with the ability to manage multiple tasks and meet deadlines.
To apply for this job:
Click the Apply Online button at the top of this page, then:
If you are currently registered with CornerStone Staffing, click the I have a username and password and want to log in button to add yourself as a candidate to this job.
If you are NOT currently registered with CornerStone Staffing, click the I need to register button to complete the application.
Please email your resume to
once you have completed you application and include "Claims Examiner" in the subject line.