Claims Examiner

Responsibilities

• Adjudicate new claims and process adjustments, including denials
• Review and resolve appeals and subrogation/third-party liability cases
• Manage individual inventory to ensure timely turnaround and production goals
• Ensure claims are processed in accordance with stop loss contract terms
• Respond to internal and external inquiries via email and other channels
• Follow up on missing or incomplete information for accurate processing
• Maintain minimum production, financial, and procedural accuracy standards

Requirements

• 1-2 years of experience in insurance claims processing
• Working knowledge of CPT and ICD-10 coding
• Basic understanding of medical terminology
• Proficiency in Microsoft Office and general computer applications
• Ability to interpret and apply plan documents
• Strong communication and customer service skills

Preferred Qualifications

• Experience with Third Party Administrator (TPA) or self-funded claims administration
• Experience with VBA systems
• Associate Degree

Benefits

• Comprehensive medical, dental, vision, and life insurance coverage
• 401(k) retirement plan with employer match
• Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
• Paid time off (PTO) and disability leave
• Employee Assistance Program (EAP)

About the Company

Point C is a National third-party administrator (TPA) that delivers customized self-funded benefit programs, focusing on cost containment strategies and innovative solutions like network and payment integrity.