HEALTHCARE CLAIMS ADJUSTOR
Core
Reviewing, assessing, and adjudicating incoming U.S. healthcare claims for accuracy and completeness, then processing payments to providers in line with Benefit Plan rules.
Role type
Healthcare Claims Adjustor
Builds
Processed claims and payments for self-funded employer groups
Domain
U.S. Healthcare Administration / Claims Processing
Deliverable
client delivery
Required skills
Claims processing, Medical coding, Benefit plan rules, Claims adjudication, Critical thinking, Independent decision making
Preferred skills
HealthRules Payer experience, Proprietary claims systems proficiency
Responsibilities
Reviewing and assessing incoming healthcare claims for accuracy and completeness, Adjudicating claims and processing payment to providers, Applying knowledge of medical coding and benefit plan rules to claims decisions, Managing multiple claims and priorities in a fast-paced environment, Escalating and flagging issues, discrepancies, or system configuration concerns, Maintaining accurate records within proprietary claims processing systems
