Medicare Claims Processor

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Medicare Claims Processor based in the United States.

• This role offers an opportunity to contribute to the operations of a growing Medicare health plan and help ensure accurate, timely claims decisions.
• You will review and process Medicare claims ranging from routine transactions to complex specialty claim research.
• Your work will involve applying CMS guidelines, benefit provisions, and organizational policies to determine appropriate claim outcomes.
• You will analyze eligibility, claim history, edits, payment levels, and insurance liability to support accurate adjudication.
• Working in a collaborative claims environment, you will interact with internal and external partners while helping resolve issues efficiently.
• Strong attention to detail, critical thinking, and knowledge of Medicare claims processes will be essential to maintaining quality and compliance.
• This is a full-time, remote opportunity suited to a detail-oriented professional who can work independently while maintaining high productivity and service standards.