Claims Adjudicator

Job Summary

Responding to incoming calls from providers regarding claims inquiries, the full-time Claims Adjudicator will provide excellent customer service, support issue resolution, and document all interactions while collaborating with various internal teams to address and resolve claims issues.

Key responsibilities

• Support resolution of provider claims issues, including analyzing systems and collaborating with operational areas to facilitate resolution
• Research claims tracers, adjustments, and resubmissions while managing high volumes of claims adjudication in a timely manner
• Document all provider interactions and assist in reviews of state and federal complaints related to claims

Required qualifications

• 2 years of experience in a clerical role within claims or customer service, preferably in a managed care organization
• Strong research and data analysis skills
• Proficiency in Microsoft Office suite and applicable software programs
• Organizational and time-management skills to handle multiple projects and meet deadlines
• Customer service experience with effective communication skills