[Remote] Claims Examiner

Note: The job is a remote job and is open to candidates in USA. Point C is a National third-party administrator (TPA) delivering customized self-funded benefit programs. They are seeking a detail-oriented Claims Examiner responsible for accurately processing medical claims while ensuring compliance with plan documents, policies, and industry regulations. Responsibilities Adjudicate new claims and process adjustments, including denials upon receipt of additional information Review and resolve appeals and subrogation/third-party liability cases Manage individual inventory to ensure timely turnaround and production goals are met Ensure claims are processed in accordance with stop loss contract terms Respond to internal and external inquiries via email and other channels within established timeframes Follow up on missing or incomplete information to ensure claims can be accurately processed Maintain minimum production, financial, and procedural accuracy standards on a monthly basis Skills At least 1+ year of experience in insurance claims processing Working knowledge of CPT and ICD-10 coding Basic understanding of medical terminology Strong communication and customer service skills Proficiency in Microsoft Office and general computer applications Ability to maintain confidentiality and comply with all company policies and procedures Able to work independently with minimal supervision Ability to prioritize, multitask, and work overtime as needed Associate's degree preferred Experience with Third Party Administrator (TPA) or self-funded claims administration preferred 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) Company Overview Point C is a network of self-insured healthcare plan third-party administrators. It was founded in 2020, and is headquartered in Chicago, Illinois, USA, with a workforce of 201-500 employees. Its website is