Senior Claims Examiner

Senior Claims Examiner

LOCATION: Irving, TX | Onsite

COMPENSATION & SCHEDULE

• Pay: $22.54 - $24.15/hour (W2)

• Schedule: Monday-Friday | 8:00 AM - 5:00 PM

• Temp to Hire, W2

• Start Date: July 27, 2026

ROLE IMPACT

Join a healthcare organization supporting accurate and timely medical claims adjudication. In this role, you will resolve complex claims, ensure compliance with federal regulations, and help maintain high-quality payment accuracy while partnering with cross-functional teams to improve claims operations.

RESPONSIBILITIES

• Review, analyze, and resolve complex medical claims in accordance with established guidelines and federal regulations.

• Process professional and institutional claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms.

• Review claims from physicians, hospitals, home health agencies, laboratories, and durable medical equipment providers.

• Investigate overpayments and underpayments, complete claim adjustments, process provider refunds, reconsiderations, and member reimbursement requests.

• Support system testing, process improvements, and serve as a resource for claims processing questions while meeting quality and productivity standards.

MINIMUM QUALIFICATIONS

• Associate Degree required (proof of education required).

• Minimum 3 years of medical claims processing experience, including CMS-1500 and CMS-1450/UB-04 claims.

• Strong knowledge of medical claims adjudication, reimbursement methodologies, and federal regulations.

PREFERRED SKILLS

• Excellent analytical, organizational, and problem-solving skills.

• Strong computer, data entry, and written/verbal communication skills.

• Ability to manage multiple priorities in a fast-paced environment.

LEGAL NOTICE

• Employment is contingent upon successful completion of a background check (criminal, education, and employment verification), drug screen, clerical testing, and any other required pre-employment screenings.

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