HealthCare Claims Adjudicator/Claims Examiner - Remote | WFH

Job Description

Evaluate and process various types of claims, including facility, professional, inpatient, and outpatient services.

Adhere to claims adjudication rules to ensure compliance with CMS regulations and internal standards.

Review Medicare, Medicaid, and Commercial services to ensure contract adherence and timely processing.

Authorize claim payments within established limits; escalate to Claims Manager as needed.

Handle refunds, appeals, disputes, and adjustments where applicable.

Identify opportunities for process improvements and recommend system enhancements within the claims department.

Education

Undertake additional responsibilities as assigned.

High School Diploma or equivalent required.

Experience

Preferred minimum of one year working closely with healthcare claims or in a claims processing/adjudication environment. Training provided for candidates without experience.

Technical Skills / Knowledge

Understanding of health claims processing and adjudication.

Ability to perform basic to intermediate mathematical computations.

Familiarity with medical terminology, particularly ICD-9 & ICD-10.

Basic proficiency in MS Office applications.

Ability to work independently as well as collaboratively in a team.

Strong time management, written, and verbal communication skills.

Attention to detail and sound decision-making abilities.

Salary: $16.00 - $20.00 per hour based on experience.

Job Type: Full-time

Benefits

Dental insurance

Health insurance

Vision insurance

Performance bonus

Referral bonus

Schedule

8-hour shifts, Monday to Friday

Flexible scheduling available

Work Location: Hybrid remote in Tampa, FL 33609

Employment Type: Temporary