Claims Adjudication Specialist

CommunityCare, Inc.; Tulsa, Northern (OK, KY); Hybrid; USD 40,000 - 60,000; Full time

Job summary

CommunityCare, Inc. in Tulsa, OK seeks a detail-oriented Claims Examiner to review and adjudicate claims prior to payment decisions.

The role emphasizes accuracy, efficiency, and compliance with benefits, limits, and regulations, including data entry, trend identification, and cross‑department collaboration.

Ideal candidates have a high school diploma and two years of related claims experience, with strong communication and math skills.

Qualifications

• Two years of related work experience in claims processing or medical billing
• High School Diploma or Equivalent required
• Ability to read and understand claims processing manuals, medical terminology, CPT codes
• Knowledge of health benefit booklets and regulations
• Demonstrated learning agility and accuracy in processing

Responsibilities

• Examine and adjudicate claims that have pended for review to determine actions (pay, deny, adjust).
• Identify claims needing additional resources and route to team lead or supervisor.
• Enter claims information using processing software to compute payments, benefits, exclusions and denials.
• Identify trends or problems during adjudication and communicate findings.
• Contribute to a positive working environment with peers and other departments.
• Assist in researching and resolving claims requiring additional investigation.
• Stay updated on changes related to claims processing, benefits, limits and regulations.

Skills

Self-motivated

Medical terminology

CPT codes

Reading health benefit booklets

Microsoft Office

Attention to detail

Numerical calculations

Written & verbal communication

Education

High School Diploma or Equivalent

Two years related work experience in claims processing or medical billing

Job description

CommunityCare, Inc. in Tulsa, OK seeks a detail-oriented Claims Examiner to review and adjudicate claims prior to payment decisions.

The role emphasizes accuracy, efficiency, and compliance with benefits, limits, and regulations, including data entry, trend identification, and cross‑department collaboration.

Ideal candidates have a high school diploma and two years of related claims experience, with strong communication and math skills.