Healthcare Claims Adjudicator ( Remote )

This role requires 1 week of onsite training in IL. This is fully paid for by the company (air travel, meals, hotel). FULLY REMOTE FROM THERE!

YOU MUST HAVE PREVIOUSE EXPERIENCE with healthcare claims adjudication and appeals on the insurance/payer side. 

Claims Adjudicator - $24.97 Hourly, amazing benefits, team, culture and growth!!!

The Claims Adjudicator II position will receive, examine, verify and input submitted claim data, determine eligibility status, and review and adjudicate claims within established timeframes.

DUTIES

Screens claims for completeness of necessary information

Verifies participant/dependent eligibility

Interprets the plan benefits from the Summary Plan Description (SPD)/Plan Documents

Codes basic information and selects codes to determine payment liability amount

Evaluates diagnoses, procedures, services, and other submitted data to determine the need for further investigation in relation to benefit requirements, accuracy of the claim filed, and the appropriateness or frequency of care rendered

Determines the need for additional information or documentation from participants, employers, providers and other insurance carriers

Handles the end to end process of Medicare Secondary Payer (MSP) files

Requests overpayment refunds, maintains corresponding files and performs follow-up actions

Handles verbal and written inquiries received from internal and external customers

Adjudicates claims according to established productivity and quality goals

Achieve individual established goals in order to meet or exceed departmental metrics

QUALIFICATIONS

3 ~ 5 years of direct experience minimum in a medical claim adjudication environment (on the payor side/insurance side) THIS IS A MUST, YOU MUST HAVE HELD THE ADJUDICATOR TITLE IN A PREVIOUS ROLE. IF NOT, PLEASE DO NOT APPPLY, THIS WILL NOT BE A FIT.

Working knowledge and experience in interpretation of benefit plans, including an understanding of limitations, exclusions, and schedule of benefits

Experience with eligibility verification, medical coding, coordination of benefits, and subrogation and it’s related processes

Ideally some subrogation experience as well. This ia huge plus, not required.

Experience with medical terminology, ICD10 and Current Procedural Technology (CPT) codes

We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), AND Pension Plan, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).

Job Type: Full-time

Pay: $24.92 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) 6% Match
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Prescription drug insurance
• Professional development assistance
• Retirement plan
• Tuition reimbursement
• Vision insurance
• Work from home

Schedule:

• 8 hour shift
• Monday to Friday
• No nights
• No weekends

Work Location: Remote