Claims Adjuster

Immediate 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

This position is primarily remote, however onsite meetings will occur 1-2x per Quarter. We are seeking candidates that reside within a 1.5 hour commute to Canton Maryland.

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!

-Education Level: High School Diploma or GED is required
-Experience: 3+ years years claims processing with at least 1 year of claims adjustment experience (healthcare, payor or provider sides)
- Must have medical claims processing / adjustment experience with payors. Medical Terminology, Provider Refund. Subrogation, Workers Comp. Disbursements.
- 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

Preferred:
- Experience with Inter-Plan Teleprocessing System (ITS) Claims
- Healthrules application
- LuminX Claims application
- BlueSquare communication systems
- Facets G6 Platform
- Workers Compensation knowledge
- Medicare / Medicaid knowledge