Claims Adjudicator

Job Summary

A company is looking for a Claims Adjudication and Quality Assurance Specialist.

Key Responsibilities

• Accurately adjudicate claims and perform detailed quality assurance reviews
• Serve as a subject matter expert in system navigation and support system updates
• Contribute to process improvements and operational documentation

Required Qualifications

• High school diploma required; associate or bachelor's degree preferred
• 2-5+ years of experience in claims processing or related healthcare operations
• Demonstrated expertise with claims processing systems
• Strong understanding of Medicaid claims preferred
• Experience identifying root causes of adjudication issues is a plus