{"schemaVersion":"jobsearcher.job.v1","id":"59dff37e5f342acce86fd559","url":"https://jobsearcher.com/jobs/59dff37e5f342acce86fd559","canonicalUrl":"https://jobsearcher.com/jobs/59dff37e5f342acce86fd559","title":"Claims Examiner Contractor","description":"Claims Examiner Contractor\n\nSmart Data Solutions, a leading provider of data management, claim routing and workflow solutions to health plans and TPAs, is looking for a Claims Examiner Contractor to join our team!\n\nWhat you’ll be doing?\n\nClaim Examiner Responsibilities\n\nIdentify, research, process and resolve claims according to desk level procedures (DLP), business guidelines, and quality standards.\nMeet established productivity and timeliness standards to achieve individual and departmental performance goals as defined.\nCapable of investigative and analytical research, demonstrating critical thinking and deductive reasoning\nConsult and coordinate with various teams/departments to obtain information to ensure proper and timely resolution of claims.\nDemonstrate a high level of flexibility and adaptability; remain available to transition to different work groups based on business need.\nEmploys strong organizational skills, makes good use of work time, and demonstrates an ability to effectively use all available resources to meet established claims processing goals.\nDemonstrate and maintain current working knowledge of the client’s systems, procedures, forms, and manuals as applicable.\nExperience with multi-tasking and prioritizing.\nThe position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.\nAdhere to all corporate and client mandatory trainings, privacy and security protocols, time entry requirements, attendance and leave time policies and guidelines.\nParticipate in departmental training and calibration meetings as needed.\nEstablish and maintain working relationships in a collaborative team environment.\nExhibit proactive approach by continuously reviewing personal and teamwork processes and sharing suggestions for improvements.\nIdentify and support automation opportunities within assigned project work.\nAccurately document your time and the number of records processed daily.\nPerform other duties as assigned.\n\nThe 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.\n\nWhat we’re looking for?\n\nRequired skills:\n\nClaim Examiner Skills and Qualifications\n\nMinimum: High School Diploma or equivalent\nExperience using computer equipment such as laptops, monitors and routers.\nIntermediate level experience with MS Office products.\nProficiency with Ten Key and Typing skills.\nAbility to read and interpret Standard Operating Procedure documents and performance / production reporting.\nMinimum of 1 year experience adjudicating claims and releasing for payment.\nFamiliarity with medical claim forms CMS1500 and UB04\nKnowledge and experience with Medical Code sets ICD 10, HCPCS, CPT and Modifiers\nConceptual knowledge of coordination of benefits, member/provider claim appeals, government programs (Medicare/Medicaid)\nAbility to maintain confidentiality and privacy.\n\nPreferred candidates possess:\n\nClaim Examiner Contractors\n\n3 years of experience in Health Care claim operations\nOrganizational skills and experience prioritizing project work and tasks.\nExperience in the health care industry working with Health Plans or Third-Party Administrators.\nExperience working in a remote environment.\n\nWhy this is the company for you?\n\nTop Benefits & Perks:\n\nA 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!\nA professional development and growth-oriented workplace\nGenerous benefits including, health insurance, short-term, and long-term disability\n401(k) with a company match to provide a better future in your retirement years\nA flexible environment with a competitive paid time off package; including vacation, holiday, give-back day, and a floating day\n\nWho is Smart Data Solutions?\n\nSmart 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.\n\nSmart Data Solutions is an equal opportunity employer.\n\nAll 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.","company":"Smart Data Solutions","rawCompany":"smart data solutions","city":"Eitzen","state":"MN","isRemote":false,"isActive":false,"createdAt":"2026-09-09T08:20:40.759Z","occupations":[{"code":"13-1031.00","title":"Claims Adjusters, Examiners, and Investigators","slug":"claims-adjusters-examiners-and-investigators"},{"code":"43-9041.00","title":"Insurance Claims and Policy Processing Clerks","slug":"insurance-claims-and-policy-processing-clerks"},{"code":"29-2072.00","title":"Medical Records Specialists","slug":"medical-records-specialists"}],"industries":[{"code":"524298","title":"All Other Insurance Related Activities","slug":"all-other-insurance-related-activities"},{"code":"524291","title":"Claims Adjusting","slug":"claims-adjusting"},{"code":"524292","title":"Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds","slug":"pharmacy-benefit-management-and-other-third-party-administration-of-insurance-and-pension-funds"}],"jobPosting":{"@context":"https://schema.org","@type":"JobPosting","title":"Claims Examiner Contractor","description":"Claims Examiner Contractor\n\nSmart Data Solutions, a leading provider of data management, claim routing and workflow solutions to health plans and TPAs, is looking for a Claims Examiner Contractor to join our team!\n\nWhat you’ll be doing?\n\nClaim Examiner Responsibilities\n\nIdentify, research, process and resolve claims according to desk level procedures (DLP), business guidelines, and quality standards.\nMeet established productivity and timeliness standards to achieve individual and departmental performance goals as defined.\nCapable of investigative and analytical research, demonstrating critical thinking and deductive reasoning\nConsult and coordinate with various teams/departments to obtain information to ensure proper and timely resolution of claims.\nDemonstrate a high level of flexibility and adaptability; remain available to transition to different work groups based on business need.\nEmploys strong organizational skills, makes good use of work time, and demonstrates an ability to effectively use all available resources to meet established claims processing goals.\nDemonstrate and maintain current working knowledge of the client’s systems, procedures, forms, and manuals as applicable.\nExperience with multi-tasking and prioritizing.\nThe position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.\nAdhere to all corporate and client mandatory trainings, privacy and security protocols, time entry requirements, attendance and leave time policies and guidelines.\nParticipate in departmental training and calibration meetings as needed.\nEstablish and maintain working relationships in a collaborative team environment.\nExhibit proactive approach by continuously reviewing personal and teamwork processes and sharing suggestions for improvements.\nIdentify and support automation opportunities within assigned project work.\nAccurately document your time and the number of records processed daily.\nPerform other duties as assigned.\n\nThe 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.\n\nWhat we’re looking for?\n\nRequired skills:\n\nClaim Examiner Skills and Qualifications\n\nMinimum: High School Diploma or equivalent\nExperience using computer equipment such as laptops, monitors and routers.\nIntermediate level experience with MS Office products.\nProficiency with Ten Key and Typing skills.\nAbility to read and interpret Standard Operating Procedure documents and performance / production reporting.\nMinimum of 1 year experience adjudicating claims and releasing for payment.\nFamiliarity with medical claim forms CMS1500 and UB04\nKnowledge and experience with Medical Code sets ICD 10, HCPCS, CPT and Modifiers\nConceptual knowledge of coordination of benefits, member/provider claim appeals, government programs (Medicare/Medicaid)\nAbility to maintain confidentiality and privacy.\n\nPreferred candidates possess:\n\nClaim Examiner Contractors\n\n3 years of experience in Health Care claim operations\nOrganizational skills and experience prioritizing project work and tasks.\nExperience in the health care industry working with Health Plans or Third-Party Administrators.\nExperience working in a remote environment.\n\nWhy this is the company for you?\n\nTop Benefits & Perks:\n\nA 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!\nA professional development and growth-oriented workplace\nGenerous benefits including, health insurance, short-term, and long-term disability\n401(k) with a company match to provide a better future in your retirement years\nA flexible environment with a competitive paid time off package; including vacation, holiday, give-back day, and a floating day\n\nWho is Smart Data Solutions?\n\nSmart 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.\n\nSmart Data Solutions is an equal opportunity employer.\n\nAll 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.","datePosted":"2026-09-09T08:20:40.759Z","dateModified":"2026-09-09T08:20:40.759Z","hiringOrganization":{"@type":"Organization","name":"Smart Data Solutions","sameAs":"https://jobsearcher.com"},"jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Eitzen","addressRegion":"MN","addressCountry":"US"}},"identifier":{"@type":"PropertyValue","name":"JobSearcher","value":"59dff37e5f342acce86fd559"},"url":"https://jobsearcher.com/jobs/59dff37e5f342acce86fd559"}}