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Medical Claims Examiner (Remote)



Posted on Monday, November 20, 2023

Position: Medical Claims Examiner (Remote)

Location: 100% Remote, must work CT hours

Hours: 8-5pm CST M-F

Compensation: $15-17/hr

About Avenica

Avenica is a career-launching platform that uses data science, behavioral psychology, and performance coaching to unleash human potential and launch careers. By getting to know candidates beyond a resume and uncovering individual potential, we jumpstart entry-level careers across the U.S. At Avenica, we put candidates first by advocating for them through the application and interview process. Learn more about Avenica and how we can support your job search at www.avenica.com.


Avenica is currently evaluating talent for Medical Claims Examiner in the health insurance industry. In this role, you would be responsible for researching, rectifying, and analyzing third-party denials, claims and other billing inquiries. No degree required!

Responsibilities for Medical Claims Examiner: 

  • Process a variety of Third Party Administrator (TPA) payments
  • Willingness to learn different claim platforms within eviCore and also client claims platforms when necessary
  • Analyzes and clears payment variances
  • Verify patients' eligibility, coverage, and benefits and identify authorization requirements related to working-aged AR.
  • Follow-up on outstanding account balances at 30 days from the date of service in accordance with client and organizational protocol with an emphasis on maximizing client satisfaction and provider profitability.
  • Process timely premium payments to providers
  • Research and answer accounts receivable discrepancies
  • Monitors payer responses, and other software as necessary to ensure prompt payment

Requirements for Medical Claims Examiner: 

  • Ability to work full time: this is a full-time role, 40hrs/week.
  • Must be legally authorized to work for any employer in the US; Avenica is unable to provide sponsorship at this time
  • High school Diploma or GED
  • 2 years minimum experience in medical billing and/or claims accounts receivable

Our Process:

Upon completing the application, you will be prompted to complete our HAALO assessment. HAALO is simply a way for us to understand your preferences, behaviors, and work styles. The assessment is the final step in our application process. 

Avenica is committed to providing equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law.