Claims Adjudicator

Job Summary

Responsible for the accurate and timely processing of claims, the full-time remote Claims Adjudicator will evaluate and process claims according to company policies and quality standards while making simple adjustments to previously processed claims.

Key responsibilities:

• Evaluates and processes claims in accordance with company policies and productivity standards
• Interprets and processes routine claims including CMS 1500 and UB04 forms
• Reviews data from system-generated reports to identify and resolve errors prior to final adjudication

Required qualifications:

• High School degree or equivalent required; Associate degree or some college coursework preferred
• Two or more years of experience in managed care claims processing preferred
• Working knowledge of medical terminology and coding sets (CPT4, HCPCS, ICD9) and HIPAA regulations
• Familiarity with UB04 and CMS 1500 forms
• Knowledge of Microsoft Office and FACETS preferred