Job Details

Job Description:
A leading organization is seeking a detail-oriented Claims Examiner to join their remote team. This role involves processing hospital and medical claims for both self-funded and level-funded groups. The Claims Examiner will determine payable amounts, deductibles, co-pays, and co-insurance limits based on contracted fee schedules and specific insurance plans. The position requires reviewing, adjusting, and processing medical insurance claims to ensure accuracy, completeness and timely payment according to policy rules. The Claims Examiner will also identify billing discrepancies, missing documentation or rejected batches and coordinate necessary corrections with providers, coders, or internal teams. This role offers the opportunity to contribute to a high-volume environment while supporting quality improvements through identifying recurring trends and opportunities.

Responsibilities:

• Process hospital and medical claims for self-funded and level-funded groups according to plan rules.
• Determine payable amounts, deductibles, co-pays, and co-insurance limits based on fee schedules and insurance plans.
• Review, adjust, and process claims to ensure they align with policy benefits.
• Identify billing discrepancies, missing documentation, or rejected batches and coordinate corrections with providers and internal teams.
• Collaborate with internal teams to address complex claims issues and ensure resolution ownership.
• Support high-volume processing environments while pinpointing recurring trends for process improvement.

Requirements:

• Experience claims processing for self-funded and level-funded groups
• Strong communication skills and sound judgment
• Attention to detail and the ability to work efficiently in a fast-paced environment
• Ability to manage multiple priorities and quickly adapt to new systems and processes
• Proficiency with CRM, Beacon Claims Administrative System, shared inbox and workflow tools, Microsoft Office and Teams, and proprietary AI-enabled service tools

Pay Range:
The anticipated pay for this position is $24.00 per hour. We understand salary is an important factor in a job search, and we encourage you to apply even if you feel that your desired compensation may fall outside of the listed range. The final pay for this position is determined based on several factors including but not limited to, relevant experience, skills and certifications, education and training, geographic location, market conditions, and internal equity. We are committed to finding the right candidate for this role and are open to discussing how your unique qualifications align with our needs.

Benefits:

• Medical insurance
• Dental insurance
• Vision insurance
• 401(k) retirement savings plan

Equal Opportunity Employer:
The Jacobson Group is committed to fostering an inclusive and equitable workplace that reflects the diverse communities we serve. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status or any other protected characteristic as defined by applicable law. We believe that diversity of thought, background and experience strengthens our team and drives innovation. All employment decisions are based on qualifications, merit and business needs. If you require a reasonable accommodation to complete the application process or participate in an interview, please contact us at HR@jacobsongroup.com or +1 (800) 466-1578 to make a request.

Refer a Colleague:
Do you know someone who would be interested in this project? Submit your referral directly by emailing the Jacobson contact listed above or submitting them through this form. If your referral is hired for a contract assignment and meets all other eligibility criteria, you will receive a referral bonus!

Contact:
Karrie Ruch
kruch@jacobsongroup.com