Web Designer, Europe (Remote)
Blackwall
Design and build Blackwall’s cybersecurity website, campaign pages, and user experiences. Turn design concepts into responsive interfaces while improving performance, SEO, analytics, and conversions.
Open
HealthEdge develops technology for healthcare payers through its HealthRules Solutions Suite. The company’s platform portfolio covers digital claims administration, care management workflows, and payment integrity, helping health plans connect operational data, automate key processes, improve payment accuracy, and support better member experiences. With a focus on healthcare and healthcare insurance, HealthEdge brings together software and consulting expertise to help payer organizations work more efficiently and coordinate care more effectively.
Medicaid Claims Examiner II
HealthEdge is seeking a Medicaid Claims Examiner II to adjudicate healthcare claims, assess coding and coverage criteria, review claim edits, and support junior examiners.
Description
- Adjudicate healthcare claims according to established policies and procedures
- Analyze claims system data to verify service appropriateness and benefit coverage
- Evaluate adjudication edits to determine payment decisions for claims and line items
- Process assigned claims under client guidelines or team leader direction
- Achieve productivity goals alongside financial and procedural accuracy standards
- Provide mentorship to junior team members
- Support special projects involving process documentation, training, quality audits, and client surge activity
- Keep management informed about issues and concerns
- Apply preventive controls to maintain processing accuracy and quality
- Contribute to projects involving provider data, authorizations, enrollment, and related activities
Requirements
- High school diploma required
- One to three years of healthcare claims processing experience
- Ability to analyze claims data effectively
- Understanding of physician and hospital coding, billing, and medical terminology
- Knowledge of CPT, HCPCS, and ICD-10
- Familiarity with UB-04 and CMS-1500 forms
- Knowledge of healthcare authorizations and related concepts
- Additional ICD-10, CPT, and HCPCS coding experience is a plus
- Willingness to develop new skills
- Collaborative approach to teamwork
- Strong work ethic
- Ability to adapt quickly in a fast-paced environment
- Self-motivated with the ability to learn quickly
- Ability to contribute effectively as a team player
- Ability to work across multiple time zones in a hybrid or remote environment
- Candidates may need to complete a pre-employment criminal background check
Benefits
- Full-time, permanent position
- Remote work environment
- Travel may be required based on company needs
- Reasonable accommodations available for individuals with disabilities
- Equal opportunity employer committed to workforce diversity
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