Employer Industry: Healthcare Services

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Work in a role that promotes compliance and confidentiality
- Chance to proactively identify and improve processes to enhance claims processing accuracy
- Engage in departmental training and participate in team functions

What to Expect (Job Responsibilities):
- Review claims for compliance with plan guidelines and approve or deny payment based on established policies
- Document claims adjudication decisions clearly and concisely in Claim Notes
- Coordinate claims adjudication against the eligibility of enrollees, including authorizations and benefit verification
- Maintain timely responses to appeals and reconsideration requests
- Perform other duties as assigned by team management

What is Required (Qualifications):
- At least 3-5 years of experience in claims adjudication, including PPO, Medicaid, ERISA, Medicare, and self-funded claims
- Excellent working knowledge of MS Access, Google Sheets, and Excel
- Knowledge of medical terminology, ICD-10, CPT, and HCPCS coding
- Excellent verbal and written communication skills to effectively interact with staff, members, and providers
- High school diploma or equivalent

How to Stand Out (Preferred Qualifications):
- Experience processing claims on the HealthEdge System
- Strong interpersonal and problem-solving skills
- Ability to work in a team environment and manage competing priorities

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