Claims Adjudication Specialist

CommunityCare HMO Inc.; Tulsa (OK); On-site; USD 42,000 - 54,000; Full time

Job summary

CommunityCare HMO Inc. is seeking a Claims Examiner in Tulsa, OK to review and adjudicate complex claims prior to payment. You will use medical terminology and CPT codes to determine accurate payments, denials, or adjustments, ensuring accuracy and efficiency.

Qualifications include a high school diploma or equivalent and at least two years in claims processing or medical billing. Proficiency in Microsoft Office is expected and teamwork is essential.

Qualifications

• Two years related work experience in claims processing, claims data entry or medical billing OR medical related education to meet minimum two years required.

Responsibilities

• Examine and adjudicate claims that require review prior to adjudication.
• Identify claims needing additional resources and route to team lead or supervisor.
• Enter claims information using processing software to compute payments, allowable amounts, limitations, exclusions and denials.
• Identify and communicate trends or problems identified during adjudication process.
• Contribute to a constructive working environment with peers and other departments.
• Investigate and solve claims requiring additional research.
• Stay current with changes to claims processing, benefits, limits and regulations.

Skills

Reading CPT codes

Medical terminology

Attention to detail

Strong communication

Microsoft Office

Education

High School Diploma or equivalent

Two years related claims processing experience

Tools

Microsoft Office

Job description

CommunityCare HMO Inc. is seeking a Claims Examiner in Tulsa, OK to review and adjudicate complex claims prior to payment. You will use medical terminology and CPT codes to determine accurate payments, denials, or adjustments, ensuring accuracy and efficiency.

Qualifications include a high school diploma or equivalent and at least two years in claims processing or medical billing. Proficiency in Microsoft Office is expected and teamwork is essential.