Claims Examiner Contractor

Identify and support automation opportunities within assigned project work.

Accurately document your time and the number of records processed daily.

Perform other duties as assigned.

The duties set forth above are essential job functions for the role. Reasonable accommodations may be made to enable individuals with disabilities to perform essential job functions.

What we’re looking for?

Required skills:

Claim Examiner Skills and Qualifications

Minimum: High School Diploma or equivalent

Experience using computer equipment such as laptops, monitors and routers.

Intermediate level experience with MS Office products.

Proficiency with Ten Key and Typing skills.

Ability to read and interpret Standard Operating Procedure documents and performance / production reporting.

Minimum of 1 year experience adjudicating claims and releasing for payment.

Familiarity with medical claim forms CMS1500 and UB04

Knowledge and experience with Medical Code sets ICD 10, HCPCS, CPT and Modifiers

Conceptual knowledge of coordination of benefits, member/provider claim appeals, government programs (Medicare/Medicaid)

Ability to maintain confidentiality and privacy.

Preferred candidates possess:

Claim Examiner Contractors

3 years of experience in Health Care claim operations

Organizational skills and experience prioritizing project work and tasks.

Experience in the health care industry working with Health Plans or Third-Party Administrators.

Experience working in a remote environment.

Why this is the company for you?

Top Benefits & Perks:

A company culture that is authentic, innovative, and collaborative! Our most powerful strength is our people! We build impactful solutions for our customers - their success is our success!

A professional development and growth-oriented workplace

Generous benefits including, health insurance, short-term, and long-term disability

401(k) with a company match to provide a better future in your retirement years

A flexible environment with a competitive paid time off package; including vacation, holiday, give-back day, and a floating day

Who is Smart Data Solutions?

Smart Data Solutions (SDS) is a technology leader in healthcare process automation and interoperability. As a strategic partner, SDS helps clients digitally transform their operations, delivering tangible value through reduced costs, streamlined workflows, and an improved customer experience. With data, AI, and automation at its core, SDS provides solutions in Digital Mailroom and Data Capture, Clearinghouse, Intelligent Medical Records, Prior Authorization and Claim Operations. Trusted by over 500 clients—including multiple Blue Cross Blue Shield plans, regional health plans, TPAs, providers, and healthcare partners—SDS streamlines complex front, middle, and back-office operations.

Smart Data Solutions is an equal opportunity employer.

All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or other legally protected status.