Remote Claims Adjudication Representative

Job Overview:
No prior industry experience is required—just a strong willingness to learn and grow! This fully remote role offers the chance to develop valuable skills in health and wellness claims adjudication, with comprehensive training provided.
As an Adjudicator, you'll assess Health Spending Account (HSA) and Wellness Spending Account (WSA) claims to determine eligibility under specific guidelines. Your role will involve evaluating receipts, reviewing claim details, and applying criteria to make informed reimbursement decisions.

Key Responsibilities:
Claims Assessment: Review and evaluate HSA and WSA claims based on established guidelines and policies.
Evidence Analysis: Examine supporting documentation to verify the validity and relevance of claims.
Decision Making: Apply eligibility criteria and guidelines to make fair and accurate reimbursement decisions.
Compliance: Ensure all decisions comply with internal policies, external regulations, and industry standards.
Customer Service: Communicate clearly and professionally with claimants regarding claim outcomes and any additional information needed.
Continuous Learning: Engage in ongoing training to stay current with changes in guidelines, regulations, and best practices.
Social Awareness and Fairness: Ensure unbiased and equitable decisions for all claimants.

Qualifications:
No prior industry experience required—we will train you!
Strong analytical and critical thinking abilities.
Excellent attention to detail and accuracy.
Proficient in using technology (we will train you on our claims management software).
Effective written and verbal communication skills.
Ability to work independently and manage time effectively in a remote work environment.
A commitment to delivering excellent customer service.