Immediate, 100% remote position for a Claims Adjuster / Processor! The selected candidate will process claims AND investigate/perform adjustments of complex Healthcare (payor) claims and ensure that claims are handled properly within authority limits, and in line with standard procedures and guidelines. The selected candidate will verify healthcare insurance claims by reviewing claims requirements; examining documentation and calculations; highlighting and summarizing out-of-line situations; recommending changes in operating processes; completing reports, logs, and audit records.

ESSENTIAL FUNCTIONS:
- 60% Proactively investigate and perform adjustments of claims. Ensure claims are handled within authority limits, and in line with standard procedures and guidelines.
- 20% Updates claims audit records by entering, verifying, and securing data.
- 10% Settle standard/complex claims through payment or denial.
- 5% Provides claims audit information and reports by collecting, analyzing, and summarizing data and trends.
- 5% Improves claims adjustment job knowledge by attending training sessions

Although this position is 100% remote, we are seeking candidates that reside in the following states: Wash DC, MD, VA, WV, NC, PA, DE, NY, NJ, TX, FL. This position is a 12 month contract to permanent opportunity with our customer, a major healthcare insurance organization who is offering a generous salary and benefits package!

Required Skills

-Education Level: High School Diploma or GED is required
-Experience: 5 years years claims adjustment and processing experience (healthcare, payor side)
- Must have medical claims processing with payors.
- Must have claims adjustment review and processing experience
-Ability to analyze information gathered from investigation
-Excellent communication skills both written and verbal
-Solid understanding of MS Excel and Outlook
-Must have basic medical terminology understanding

Preferred:
- Experience with Inter-Plan Teleprocessing System (ITS) Claims
- Healthrules application
- LuminX Claims application
- BlueSquare is their communication systems