Claims Adjudicator: Detail-Oriented Investigator

CommunityCare HMO Inc.; Tulsa (OK); Presencial; USD 42.000 - 64.000; Jornada completa

Descripción de la vacante

CommunityCare HMO Inc. is seeking a Claims Examiner in Tulsa, OK to review claims prior to adjudication. The examiner will apply resources, knowledge, and decision-making to determine payments, denials, or adjustments with accuracy and efficiency.

The role requires reading claims processing manuals and health benefit terminology, CPT codes, and performing basic data entry and calculations. Candidates should be self-motivated with attention to detail and proficient in Microsoft Office.

Formación

• Two years related work experience in claims processing, data entry or medical billing.
• Strong understanding of CPT codes and health benefit terminology.
• Ability to read claims processing manuals and health benefit booklets.

Responsabilidades

• Examine and adjudicate claims pending for review to determine payments or denials.
• Identify claims needing additional resources and route to the appropriate supervisor or department.
• Enter claims information using processing software to compute payments, allowable amounts, limitations and denials.
• Identify and communicate trends or problems seen during adjudication.
• Support peers and other departments to maintain a pleasant work environment.
• Assist in investigating and solving claims requiring additional research.
• Continuously adapt to changes in claims processing, benefits, limits and regulations.
• Perform other job-related duties as assigned.

Conocimientos

Claims processing

Medical terminology

CPT codes

Data entry

Microsoft Office

Two years related work experience in p

Educación

High School Diploma or Equivalent

Herramientas

Processing software

Descripción del empleo

CommunityCare HMO Inc. is seeking a Claims Examiner in Tulsa, OK to review claims prior to adjudication. The examiner will apply resources, knowledge, and decision-making to determine payments, denials, or adjustments with accuracy and efficiency.

The role requires reading claims processing manuals and health benefit terminology, CPT codes, and performing basic data entry and calculations. Candidates should be self-motivated with attention to detail and proficient in Microsoft Office.