Claims Adjustment Specialist

Job Summary

To support a growing healthcare organization, the full-time Claims Adjustment Specialist will review and adjust claims, investigate discrepancies, and collaborate with cross-functional teams while working onsite in Pearland, Texas, with some remote flexibility.

Key responsibilities:

• Review claims for corrections due to processing errors and perform necessary adjustments in accordance with policies
• Investigate discrepancies impacting claim outcomes and document actions clearly within the claims system
• Collaborate with various departments to resolve complex claim scenarios and support quality improvement initiatives

Required qualifications:

• High School Diploma or GED
• 2+ years of claims adjudication experience in an HMO, PPO, or TPA environment
• Working knowledge of claim adjudication workflows and benefit interpretation
• Proficiency with Microsoft Office Suite and spreadsheet tracking
• Ability to interpret claim data and supporting documentation effectively