Senior Claims Adjudicator

Responsibilities

• Adjudicate claims for timely review and appropriate reimbursement
• Analyze claims data to determine eligibility and apply appropriate contract provisions to the medical facts of the claim
• Work with claims staff, underwriters, and advise brokers on adjudication results and resolve claim inquiries
• Provide support for inquiries on adjudication methods and outcomes to claims staff
• Research and review state reimbursement fee schedules
• Other support requirements, as necessary

Qualifications

• Bachelor’s degree (or equivalent college education)
• 10+ years of claims adjudication, claims processing, health insurance, or related experience
• Strong attention to detail and organizational skills
• Knowledge of medical terminology, insurance benefits, and claims adjudication principles
• Ability to interpret plan documents, contract provisions, eligibility requirements, and reimbursement guidelines
• Clear written and verbal communication skills
• Ability to work well independently as well as within a team environment
• Proficiency (Microsoft Office Product Suite)