Medical Claims Adjudicator

Job Summary

To support a growing healthcare team, the full-time Medical Claims Adjudicator will examine, verify, and process medical claims, ensuring eligibility and accuracy while working remotely after an initial onsite training period in Oak Brook, IL.

Key responsibilities

• Screen and verify claims for completeness and participant eligibility
• Interpret plan benefits and determine payment liability based on submitted data
• Adjudicate claims according to established productivity and quality goals while handling inquiries from customers

Required qualifications

• 3 to 5 years of direct experience in a medical claim adjudication environment
• Working knowledge of benefit plan interpretation, including limitations and exclusions
• Experience with eligibility verification, medical coding, and coordination of benefits
• Familiarity with medical terminology, ICD10, and CPT codes
• Fluency in Spanish is preferred