**Overview** *Required On-site training in **Campbell, CA** (Beautiful Bay Area!) for a week. BroadPath is hiring a detail-oriented **Claims Examiner** looking to make a significant impact in the healthcare industry. Join our team as a **Claims Examiner** and play a crucial role in ensuring the financial integrity and efficiency of our healthcare organization . The **Claims Examiner's** will be responsible for accurately processing a wide range of claims, identifying and resolving complex issues, and providing top-notch customer service to our valued providers and members. **Responsibilities** + Adjudicate a variety of claims, including routine and complex cases, resolving system edits and audits for both hardcopy and electronic submissions. + Effectively communicate with providers and members to address issues related to claims, eligibility, and authorizations. + Generate emergency reports and authorizations for claims lacking prior approval. + Process third-party liability and coordination of benefit claims in accordance with company policies. + Assist in the review of stop loss reports to identify members approaching reinsurance thresholds. + Escalate potential system programming issues to supervisors for resolution. + Provide guidance and training to less experienced claims processors. + Recognize and appropriately route claims for carved-out services according to plan contracts. + Apply knowledge of plan contracts, provider pricing, member eligibility, referral authorization procedures, benefit plans, and capitation arrangements. + Collaborate with the Accounting team to ensure accurate posting of claims information to general ledger accounts. + Work closely with Customer Service and Provider Services departments on large claim projects and adjustments. + Interpret benefit and plan details for customers through the use of the cut-log system when necessary. + Assist senior examiners in the adjustment of complex claims. + Perform other duties as assigned by management. **Qualifications** + High school diploma or equivalent required + 1-3 years of Medicare claims processing experience + Knowledge of ICD-9, CPT, HCPC, and Revenue Coding + Strong analytical and problem-solving skills to address claim issues and troubleshoot problems + Excellent communication and customer service skills to effectively interact with providers and members + Attention to detail and the ability to maintain focus in a high-volume, production-oriented environment + Proficiency with claims processing software and technology + Understanding of medical terminology, coding, and healthcare industry regulations + Ability to learn and apply complex claims procedures and policies + Teamwork skills to collaborate with colleagues and provide training or support + Adaptability to work under demanding performance standards for production and quality **Preferred Qualifications:** + Commercial Claims Experience, QNXT Must be available for a minimum of 7 days of travel. On-Site Training: This role requires on-site training in Campbell, CA. **Diversity Statement** At BroadPath, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation! Equal Employment Opportunity/Disability/Veterans If you need accommodation due to a disability, please email us at HR@Broad-path.com. This information will be held in confidence and used only to determine an appropriate accommodation for the application process BroadPath is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law. **Compensation:** BroadPath has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.