Experienced Managed Care Claims Examiner - U.S. Remote

Experienced Managed Care Claims Examiner - U.S. Remote Job Type: Full-Time Work Location: U.S. Remote Work Hours: Pacific Time Zone Position Overview We are seeking an Experienced Managed Care Claims Examiner to join our growing healthcare operations team. This role is responsible for accurately reviewing, investigating, adjudicating, and resolving medical claims and provider dispute requests in accordance with payer guidelines, contractual agreements, regulatory requirements, and internal policies. This is a fast-paced, production-driven role requiring strong analytical skills, attention to detail, and the ability to process a broad range of claim scenarios. Successful candidates must be comfortable navigating complex claims, applying multiple benefit and reimbursement rules, and managing a high-volume workload while maintaining quality and accuracy standards. The ideal candidate is self-motivated, accountable, adaptable, and committed to continuous learning and professional growth. Key Responsibilities Review and adjudicate medical claims while ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies. Process a broad range of claim types, including professional, institutional, adjusted, corrected, and other complex claim scenarios. Review and investigate provider dispute requests (PDRs), appeals, reconsiderations, and claim adjustments. Verify member eligibility, provider participation, benefit coverage, and supporting documentation t