Medical Bill Examiner III

Med Bill Examiner III - CJ10AN
We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals - and to help others accomplish theirs, too. Join our team as we help shape the future.

The Medical Bill Examiner III is an experienced claims professional responsible for the accurate review, analysis, and adjudication of complex medical bills. This role applies advanced knowledge of medical billing practices, coding standards, fee schedules, and regulatory requirements to ensure compliance, accuracy, and cost containment. The Med Bill Examiner III functions with a high level of independence and may serve as a subject matter resource for lower-level examiners.

Key Responsibilities

• Review, audit, and adjudicate complex medical bills for accuracy, medical necessity, and compliance with applicable fee schedules, contracts, and regulations.
• Analyze CPT, HCPCS, ICD codes and supporting documentation to identify discrepancies, overbilling, duplicate charges, or non-covered services.
• Apply state-specific guidelines, provider contracts, and internal policies when determining appropriate reimbursement.
• Document billing determinations clearly and thoroughly to ensure audit readiness and compliance.
• Communicate billing outcomes, discrepancies, or requests for additional documentation to internal partners, providers, or vendors.
• Resolve billing disputes and escalated issues using sound judgment and investigative analysis.
• Maintain productivity and quality standards in a high-volume environment.
• Support process improvements and contribute to consistency and best practices across the medical bill review function.
• May mentor or provide guidance to Medical Bill Examiner I or II staff.

• Advanced experience in medical bill review, claims adjudication, or medical billing audit.
• Strong working knowledge of medical coding (CPT, HCPCS, ICD), fee schedules, and billing regulations.
• Demonstrated analytical, investigative, and critical-thinking skills.
• High attention to detail with strong documentation discipline.
• Ability to manage workload independently while meeting accuracy and turnaround expectations.
• Effective written and verbal communication skills.
• Comfort handling complex or disputed billing scenarios.

• Experience in workers' compensation, auto, or group health medical billing.
• Prior exposure to regulatory or compliance-driven environments.
• Experience functioning as a senior or lead examiner.

• This role can have a Hybrid or Remote work arrangement. Candidates who live near one of our offices (San Antonio, TX; Lake Mary, FL; Naperville, IL; Hartford, CT) will have the expectation of working in an office 3 days a week (Tuesday through Thursday). Candidates who do not live near an office will have a remote work arrangement, with the expectation of coming into an office as business needs arise. Only requirement is you agree to work the necessary core hours based on the time zones of the States that you are assigned to handle.

• Medical, Dental, Vision, Life and Disability Insurance. Effective day 1.
• 25 days paid time off in your first full year and Paid Holidays
• Click on this link to learn more about our comprehensive benefits package and award-winning well-being program: https://www.thehartford.com/careers/benefits
• Tuition reimbursement - up to $5,250 (undergraduate) and $6,000 (graduate) for tuition and registration fees for degree programs that support your career development (subject to additional requirements) .