Claims Adjudicator

Independent Health; Buffalo (NY); On-site; USD 60,000 - 80,000; Full time

Job summary

Join a forward-thinking organization dedicated to diversity and inclusion as a Claims Adjudicator. In this role, you'll be pivotal in ensuring claims are processed accurately and efficiently, adhering to established guidelines. Your expertise in medical billing and customer service will shine as you tackle challenges and contribute to a collaborative environment. With a commitment to excellence and a focus on performance, you'll help maintain the integrity of claims processing while enjoying a supportive workplace that values your contributions. This is an exciting opportunity to grow your career in a dynamic setting where your skills will make a real difference.

Benefits

Generous Paid Time Off

Full Range of Benefits

Scorecard Incentive

Qualifications

• 1 year of experience in customer service or medical claims processing required.
• Knowledge of medical billing procedures and coding preferred.

Responsibilities

• Adjudicate claims based on established policies and procedures.
• Communicate effectively with departments to resolve claims issues.

Skills

Customer Service

Medical Claims Processing

Medical Billing

Data Entry

Problem Resolution

Communication Skills

Organizational Skills

Education

High School Diploma or GED

Tools

Microsoft Office

Job description

We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion.

Overview

The Claims Adjudicator shall be responsible for adjudicating claims against established criteria and address incoming inquiries to ensure that all claims are paid in support of established rules, regulations, performance guarantees and department targets.

Qualifications

• High school diploma or GED required.
• One (1) year of experience in customer service, medical claims processing, medical billing or collections required.
• Knowledge of medical billing procedures; CPT and ICD-9 coding and medical terminology knowledge preferred.
• Proficiency with data entry skills and Microsoft Office products.
• Demonstrated experience with independent decision making to include effective problem resolution.
• Solid organizational skills with attention to detail and follow through.
• Good written, verbal and interpersonal communication skills. Demonstrated ability to effectively communicate with internal and external customers.
• Must be able to work collaboratively. Flexibility to work additional hours as needed.
• Ability to meet or exceed all department goals to include accuracy and productivity.
• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Essential Accountabilities

Technical Proficiency

• Adjudicate claims based on established policies and procedures for facility, professional, member submitted, pharmacy and dental claim edits. This is inclusive for both in and out-of-network benefits.
• Review vouchers/explanation of payments to identify and resolve claims related issues.
• Continually meet or exceed department performance measures as it relates to production, accuracy, knowledge of policy and procedure and timeliness of claims adjudication.
• Analyze, identify and research, as needed, edits which demonstrate inconsistency in regards to policy, payment issues and coding issues.
• Maintain current contract, summary plan description and benefit knowledge.
• Ability to adhere to departmental deadlines and turn-around times, in order to be compliant with State and Federal regulations.

Communication

• Effective written, verbal and interpersonal communication with other departments within Independent Health to resolve problems related to claims payment.

Additional Information

Immigration or work visa sponsorship will not be provided for this position.

Hiring Compensation Range: $18.00 hourly. Compensation may vary based on factors including but not limited to skills, education, location and experience.

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.

Current Associates must apply internally via the Job Hub app.