Claims Adjudicator I

Hawaii-Western Management Group Inc; Honolulu (HI); On-site; USD 37,000 - 45,000; Full time

Job summary

Hawaii-Western Management Group Inc in Honolulu, HI is seeking a Claims Analyst to analyze health plan claims, determine liability, and make benefit determinations in line with plan guidelines and policy provisions. This full-time role offers the opportunity to work with a dedicated team in a health insurance environment.

The position requires a high school diploma or GED, knowledge of CPT/ICD/HCPCS, and proficiency in Word/Excel, with CPC certification preferred.

Qualifications

• High school diploma or GED required; college/technical certificate preferred.
• Experience in medical claims processing is a plus.
• Proficiency in Microsoft Word and Excel.
• Knowledge of CPT, ICD, and HCPCS coding.
• Strong organizational and decision-making skills.
• Ability to prioritize and meet deadlines.
• Strong data entry skills (10-key by touch) and attention to detail.
• Ability to work independently and in a team.
• Certified Professional Coder (CPC) certification is preferred.

Responsibilities

• Analyzes claims to determine the extent of the health plan's liability and makes benefit determinations on claims in accordance with plan benefits, processing guidelines, and policy provisions.

Skills

Medical terminology

CPT/ICD/HCPCS codes

Word/Excel

Data entry (10-key)

Independent & team work

Decision making

Education

High school diploma or GED

Technical or college certificate

Certified Professional Coder (CPC) preferred

Tools

Microsoft Word

Microsoft Excel

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time Honolulu, HI, US

30+ days ago Requisition ID: 1001

Salary Range: $37,000.00 To $45,000.00 Annually

Summary

Analyzes claims to determine the extent of the health plan’s liability and makes benefit determinations on claims in accordance with plan benefits, processing guidelines, and policy provisions.

Qualifications

• High school diploma or general education degree (GED) is required. Certificate from college or technical school; experience in medical claims processing at a health insurance company or third-party administrator; or an equivalent combination of education and experience is preferred.
• Basic-level proficiency in Microsoft Word and Excel
• Knowledge of medical terminology, CPT, ICD, and HCPCS codes
• Good organizational and decision-making skills
• Able to prioritize and consistently meet deadlines
• Strong data entry skills, 10-key by touch, and attention to detail
• Work independently and in a team environment
• Certified Professional Coder (CPC) certification is preferred

Expected Starting Salary: $37,000 - $45,000 annually. Full salary range is broader and depends on experience.