Claims Adjudicator

Bishop & Company, Inc.; Honolulu (HI); On-site; USD 37,000 - 45,000; Full time

Benefits offered by this job

Paid holidays

Paid vacation

Health insurance

Matching 401k

Job summary

Bishop & Company, Inc. in Honolulu seeks a detail-oriented Claims Adjudicator to review medical claims and determine health plan liabilities, ensuring accurate benefit determinations in line with plan benefits and guidelines.

You will use CPT, ICD, and HCPCS coding, enter data in systems, and collaborate with the Claims team to meet deadlines. Temp-to-hire or direct-hire; salary range $37,000–$45,000.

Qualifications

• High school diploma or GED required.
• Basic proficiency in Word and Excel.
• Knowledge of medical terminology and CPT, ICD, and HCPCS.
• Strong organizational and time-management skills.
• Ability to work independently and as part of a team.
• Attention to detail in data entry and claim processing.

Responsibilities

• Analyze and adjudicate medical claims accurately and efficiently.
• Determine the health plan's liability based on benefits and policy provisions.
• Apply medical terminology and coding to evaluate claims.
• Enter and maintain claim information in applicable systems.
• Review claims for completeness and adherence to processing guidelines.
• Prioritize workload and meet established deadlines.
• Work independently and collaboratively with the Claims team.

Skills

Attention to detail

Independent work

Team collaboration

Time management

Education

High school diploma or GED

Tools

Microsoft Word

Microsoft Excel

Job description

Claims Adjudicator Bishop and Company is seeking a Claims Adjudicator to join our client's Claims team. This is a full-time opportunity available on either a temp-to-hire or direct-hire basis. The Claims Adjudicator is responsible for reviewing and analyzing medical claims to determine the health plan’s financial liability and making accurate benefit determinations in accordance with plan benefits, processing guidelines, and applicable policy provisions.

Key Responsibilities

• Analyze and adjudicate medical claims accurately and efficiently.
• Determine the extent of the health plan’s liability based on plan benefits, guidelines, and policy provisions.
• Apply knowledge of medical terminology and coding to evaluate claims.
• Enter and maintain claim information accurately within applicable systems.
• Review claims for completeness, accuracy, and adherence to established processing guidelines.
• Prioritize workload and consistently meet established deadlines.
• Exercise sound judgment and decision-making when resolving claims-related issues.
• Work independently while also collaborating effectively with members of the Claims team.

Qualifications

• High school diploma or GED.
• Basic proficiency in Microsoft Word and Excel.
• Knowledge of medical terminology and CPT, ICD, and HCPCS codes.
• Strong organizational and decision-making skills.
• Ability to prioritize tasks and consistently meet deadlines.
• Strong data-entry skills, including 10-key by touch.
• Exceptional attention to detail.
• Ability to work independently and effectively as part of a team.

Preferred qualifications

• Certificate or coursework from a college or technical school.
• Previous experience in medical claims processing with a health insurance company or third-party administrator (TPA).
• Equivalent combination of education and relevant experience.
• Certified Professional Coder (CPC) certification.

Additional Information

Job Type: Temp-to-hire or direct hire opportunity.

Annual salary: $37,000–$45,000, depending on qualifications and experience.

Full-time employment.

Convenient downtown Honolulu office location.

Monthly parking available for $80 per month, or mass transit reimbursement of $63 per month.

Schedule: Monday-Thursday 7:00 am to 4:00 pm and Fridays 7:00 am to 3:00 pm (1-hour lunch break).

In-office every workday.

Benefits

Bishop & Company offers its temporary and contract employees attractive, competitive benefits, including paid holidays, paid vacation, health insurance, and matching 401k plan for all those who qualify!

• paid holidays
• paid vacation
• health insurance
• matching 401k plan for all those who qualify!

Equal Opportunity Employer – Disability and Veteran