Job Description

Claims Adjustment Examiner

Location: Remote

Work authorization: US Citizen or US Green Card only

Hours: Mon- Fri 7:30AM -3:30 PM EST or 8:00 AM - 4:30 PM EST

Compensation: $23 per hour

Position Summary: The Claims Adjustment Examiner position is integral to ensuring the accuracy and integrity of medical, dental, and vision claims processing. Your role involves thorough examination and adjustment of claims to align with the outlined plan guidelines, providing a crucial link between our clients and their health benefits. By diligently reviewing each submission, you will play an essential part in upholding the trust that our clients place in us, contributing significantly to their overall experience with our services.

This role demands not only keen analytical skills but also a compassionate approach, as you will often be interacting with clients to clarify and resolve issues related to their claims. As you navigate the complexities of the claims process, you will find yourself immersed in a diverse and dynamic environment that values accuracy, efficiency, and customer satisfaction.

Additional Job Duties:

• Examine and process medical claims in adherence to plan guidelines while ensuring completion within set turnaround times.

• Interpret and apply medical plan guidelines to guarantee proper coding in our systems.

• Assess the legitimacy and correctness of claims to maintain a high standard of accuracy.

• Meet and exceed the production and quality benchmarks established for adjusters, contributing to the overall efficiency of the team.

• Allocate over-payments and refunds appropriately to resolve any existing financial discrepancies.

• Assist in addressing customer service inquiries regarding claims, providing clarity and guidance to enhance the client experience.

• Review additional documentation swiftly to adjust claims accordingly, ensuring that all submissions are processed accurately based on newly provided information.

• Undertake other responsibilities as delegated to support the overall objectives of the claims department.

Requirements:

• High School Diploma or GED is required.

• Proven problem-solving skills and the ability to interpret benefit plans effectively.

• Familiarity with CPT codes, ICD9/ICD10 coding, and medical terminology is an asset.

• Adept at working independently, demonstrating initiative and self-motivation in daily tasks.

• Proficient in computer operations with the capability to engage with relevant software effortlessly.

• Possess average typing skills to ensure timely input of data and communication

Preference:

• Associate's degree or higher.