Healthcare Claims Adjudicator — Fast-Paced & Precise

Remotedxb; Dubai; On-site; AED 60,000 - 90,000; Full time

Job summary

Centivo is seeking a claims processor to adjudicate claims in assigned queues, applying written Policies and SPD. You will review system edits to ensure benefits are applied correctly and route inconsistencies to Plan Build or Provider Maintenance teams.

You will deny claims when information is missing, generate concise correspondence to participants or providers, and maintain daily, weekly, and monthly production levels while supporting quality improvement initiatives.

Qualifications

• Must have a high school diploma or GED.
• Experience with automated, integrated claims processing systems.
• Knowledge of healthcare claims, medical coding, and Benefit Plan rules.
• Excellent oral and written communication skills.
• Ability to work in a fast-paced environment with production deadlines.
• Proficiency in Microsoft Office and web-based software.
• Strong critical thinking and independent decision-making skills.

Responsibilities

• Adjudicate claims in assigned work queues based on Policies, Procedures, and SPD.
• Review system-generated edits to ensure benefits are applied correctly per client funds.
• Route claims to Plan Build or Provider Maintenance teams for inconsistencies or pricing discrepancies.
• Deny claims for additional information when necessary and generate concise correspondence to participants or providers.
• Maintain daily, weekly, and monthly production levels.
• Participate in department quality improvement and process improvement efforts.
• Process claims under moderate supervision while meeting production and quality goals.

Skills

Critical thinking

Independent decision-making

Communication skills

Microsoft Office

Web-based software

Ability to work under deadlines

Education

High School diploma or GED

Tools

HealthRules Payer

Job description

Centivo is seeking a claims processor to adjudicate claims in assigned queues, applying written Policies and SPD. You will review system edits to ensure benefits are applied correctly and route inconsistencies to Plan Build or Provider Maintenance teams.

You will deny claims when information is missing, generate concise correspondence to participants or providers, and maintain daily, weekly, and monthly production levels while supporting quality improvement initiatives.