Medicare Claims Processor

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Medicare Claims Processor based in the United States. This role offers an opportunity to contribute to the operations of a growing Medicare health plan and help ensure accurate, timely claims decisions. You will review and process Medicare claims ranging from routine transactions to complex specialty claim research. Your work will involve applying CMS guidelines, benefit provisions, and organizational policies to determine appropriate claim outcomes. You will analyze eligibility, claim history, edits, payment levels, and insurance liability to support accurate adjudication. Working in a collaborative claims environment, you will interact with internal and external partners while helping resolve issues efficiently. Strong attention to detail, critical thinking, and knowledge of Medicare claims processes will be essential to maintaining quality and compliance. This is a full-time, remote opportunity suited to a detail-oriented professional who can work independently while maintaining high productivity and service standards.