Claims Examiner I

Rosemont, IL, 60018

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Type: Contract

Reference ID: 33609985

Date Posted: 11/10/2026



Title: Claims Examiner I
Employment Type: Contract
Duration: 4–6 months initially
Location: 100% Remote
Pay Rate: $20-$24 per hour
Target Start Date: November 30, 2026
Benefits: Eligible for Health, Dental, Vision, 401K
Must be authorized to work in the U.S. This position is not eligible for sponsorship.

Position Overview

We are seeking a Claims Examiner I to review, analyze, and process medical claims to determine appropriate payment or denial. The ideal candidate will have hands-on claims processing experience, HMO experience, and knowledge of commercial, Medicare, and Medicaid health plans.

Key Responsibilities

  • Review and process medical claims to determine appropriate payment or denial.

  • Verify claim accuracy, payment amounts, and required authorizations.

  • Research and resolve claims with system errors or payment holds.

  • Identify recurring provider and member issues and recommend solutions.

  • Coordinate payments between insurance companies when applicable.

  • Research and resolve claims-related questions and issues.

  • Identify opportunities to improve claims processing workflows.

  • Maintain accurate procedures and documentation.

  • Follow HIPAA guidelines and protect confidential patient information.

  • Work collaboratively with team members and management to meet department goals.

Required Qualifications

  • Associate's degree or equivalent experience.

  • 2–3 years of relevant professional experience, including hands-on claims processing.

  • Previous HMO experience.

  • Experience processing medical claims.

  • Knowledge of Commercial, Medicare, and Medicaid health plans or TPA organizations.

  • Strong attention to detail and accuracy.

  • Excellent organizational, analytical, and communication skills.

  • Proficiency in Microsoft Office and ability to learn new software systems.

Preferred Qualifications

  • Knowledge of CPT-4, HCPCS, and ICD-10 coding.

  • Familiarity with medical terminology.

  • Understanding of medical billing, provider networks, and contracted rates.

  • Experience with claims authorizations and coordination of benefits (COB).

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