Claims Adjudicator: Precise Decisions & Fast Processing

CommunityCare, Inc.; Tulsa, Northern (OK, KY); Hybrid; USD 42,000 - 56,000; Full time

Job summary

CommunityCare, Inc. is seeking a Claims Examiner in Tulsa, OK to review and adjudicate claims before payment.

You will use your knowledge of CPT codes, health benefit booklets and processing rules to determine actions on each claim and maintain accuracy and efficiency. The role requires reading comprehension, strong numerical ability and proficient use of Microsoft Office; you will collaborate with teams and other departments to resolve complex claims and ensure proper payment or denial as

Qualifications

• High School Diploma or Equivalent required.
• Two years related work experience in claims processing, claims data entry or medical billing OR medical related education to meet minimum two years required.

Responsibilities

• Examine and adjudicate claims that have pended for review using available resources and decision-making.
• Route claims requiring additional resources to team lead or other departments.
• Enter claims information using processing software to compute payments, allowable amounts, limitations, exclusions and denials.
• Identify trends or problems identified during adjudication process.
• Contribute to a pleasant working environment with peers and other departments.
• Assist in investigating and solving claims that require additional research.
• Learn and adapt to changes related to claims processing, benefits, limits and regulations.
• Perform other job-related duties as assigned.

Skills

Claims processing

Reading comprehension

Attention to detail

Microsoft Office

Communication skills

Basic mathematics

Health care terminology

Education

High School Diploma

2 years related experience / medical billing education

Tools

Processing software

Job description

CommunityCare, Inc. is seeking a Claims Examiner in Tulsa, OK to review and adjudicate claims before payment.

You will use your knowledge of CPT codes, health benefit booklets and processing rules to determine actions on each claim and maintain accuracy and efficiency. The role requires reading comprehension, strong numerical ability and proficient use of Microsoft Office; you will collaborate with teams and other departments to resolve complex claims and ensure proper payment or denial as