Claims Adjudication Specialist: Efficient & Accurate

TCH Medical Center; Bellaire (TX); On-site; USD 40,000 - 60,000; Full time

Job summary

TCH Medical Center is seeking a Claims Examiner to support our growing team. You will process and adjudicate claims for reimbursement to Providers based on our detailed claim processing procedures.

You will thoroughly review, investigate, and adjudicate claims daily, aiming to resolve oldest claims within 30 days with high accuracy and efficiency, targeting 98% accuracy in audits.

Examiners are expected to maintain clear documentation and complete special projects as requested.

Qualifications

• Requires HS diploma or GED.
• At least 1 year claims examination experience.

Responsibilities

• Adjudicate claims received into processing system.
• Thoroughly review, investigate, and adjudicate claims daily with 30-day resolution goal.
• Process at least 14 claims per hour or 98 per day with accuracy.
• Follow up on pended claims to finalize resolution within 30 days.
• Ensure 98% accuracy per monthly audits and ongoing notes for each claim.
• Enter clear, concise documentation for each adjudicated claim.
• Complete special projects as requested.

Skills

Claims processing

Adjudication

Documentation

Education

High School Diploma or GED

Job description

TCH Medical Center is seeking a Claims Examiner to support our growing team. You will process and adjudicate claims for reimbursement to Providers based on our detailed claim processing procedures.

You will thoroughly review, investigate, and adjudicate claims daily, aiming to resolve oldest claims within 30 days with high accuracy and efficiency, targeting 98% accuracy in audits.

Examiners are expected to maintain clear documentation and complete special projects as requested.