Medical Claims Adjuster

Some responsibilities include:

Responsibilities

Review and make adjustments or corrections to previously processed claims by researching and investigating issues, making a determination, then communicating decisions as required
Research and review assigned claims by navigating multiple computer systems and platforms and accurately capture the data/information necessary for processing (e.g. verifying pricing, prior authorizations, etc.) and communicate extensively with members and providers regarding adjustments to resolve claims errors
Complete necessary adjustments to claims and ensure the proper benefits are applied to each claim by using the appropriate processes and procedures

Basic Qualifications

Minimum of one year of recent experience as a Medical Claims Adjuster
Knowledge of medical claim forms (HCFA and UB)
Knowledge of coding (ICD-9, ICD-10, HCPCS, CPT)
Must have strong technical skills (Microsoft Windows, keyboarding skills, strong systems aptitude, advanced Microsoft Excel knowledge, etc.)
Requires excellent verbal and written communication skills
Ability to remain focused and productive each day though tasks may be repetitive