Hybrid Claims Adjudicator

Overview:

We are seeking a Claims Adjudicator in Winston Salem, North Carolina with 1 to 2 years of experience in Claims Adjudication. Training will be 4-6 weeks In-Office, then this role will be 100% remote. The ideal candidate will have a good understanding in Medicare, Medicaid Claims, Appeals and Grievances, and Commercial Claims. With a focus on accuracy and timeliness you will utilize your expertise in MS Excel to analyze data and support the claims process. This hybrid role offers a balanced work environment allowing you to contribute effectively while maintaining a healthy work-life balance.

Responsibilities:

• Analyze and process claims with precision to ensure timely resolution and customer satisfaction.
• Utilize MS Excel to manage and interpret data enhancing the efficiency of claims processing.
• Collaborate with team members to identify trends and patterns in claims data for continuous improvement.
• Communicate effectively with stakeholders to provide updates and resolve any issues related to claims.
• Ensure compliance with company policies and industry regulations throughout the claims process.
• Support the appeals and grievances process by providing accurate data and insights.
• Contribute to the development of process improvements to streamline claims operations.
• Maintain accurate records and documentation for all claims activities.
• Assist in training new team members on claims processes and best practices.
• Participate in regular team meetings to discuss progress and share insights.
• Provide exceptional customer service by addressing inquiries and concerns promptly.
• Monitor and report on key performance indicators related to claims processing.
• Adapt to changing priorities and work effectively in a fast-paced environment.

Qualifications:

• High School Diploma Required
• Should have at least 2 years of experience in the medical field, either through work or volunteer roles.
  • FACETS experience is an added advantage
• Experience in claims hospital and professional claims adjudication is mandatory.
• Experience in other clinical services search program management and health records is an added advantage.
• A strong understanding of Claims, Appeals and Medical Benefits
• Proficiency in computer skills including typing speed and accuracy
• Good written and verbal communication skills
• Ability to maintain a high level of integrity and confidentiality of medical information