Detail-Oriented Claims Adjudicator

CommunityCare; Tulsa (OK); On-site; USD 40,000 - 60,000; Full time

Job summary

CommunityCare is seeking a Claims Examiner to review and adjudicate claims prior to adjudication, applying knowledge of CPT codes and health benefit terms. The role supports accuracy and efficiency in processing and requires strong attention to detail.

Responsibilities include routing complex claims, entering data into processing systems, and communicating trends. A background check is required, with a focus on compliance and process improvement within a collaborative team environment.

Qualifications

• Must understand claims processing manuals and medical terminology.
• Familiar with CPT codes and basic processing procedures.
• Ability to read health benefit booklets.
• Demonstrated learning agility.
• Background check for Health Care Sanctions completed.
• Knowledge of managed care plan terms and rates.
• Understanding of unbundling methods, COB and over-billing.
• Strong attention to detail.
• Proficient with Microsoft Office applications.
• Ability to perform basic mathematical calculations.
• Strong oral and written communication skills.

Responsibilities

• Examine and adjudicate claims that are pending review to determine actions.
• Identify claims needing additional resources and route to team lead or supervisor.
• Enter claims information using processing software to compute payments, allowances, and denials.
• Identify and communicate trends or problems found during adjudication.
• Contribute to a collaborative, pleasant working environment with peers and other departments.
• Assist in investigating and solving claims requiring additional research.
• Continuously learn and adapt to changes in claims processing, benefits, limits and regulations.
• Perform other job-related duties as assigned.

Skills

Self-motivated

Claims processing literacy

Health care manuals & CPT

Health-benefit booklets

Learning agility

Background check compliance

Managed care knowledge

Unbundling & COB knowledge

Attention to detail

Microsoft Office

Basic math

Oral & written communication

Education

High School Diploma or Equivalent

2 years related experience in claims processing or medical billing (education acceptable)

Job description

CommunityCare is seeking a Claims Examiner to review and adjudicate claims prior to adjudication, applying knowledge of CPT codes and health benefit terms. The role supports accuracy and efficiency in processing and requires strong attention to detail.

Responsibilities include routing complex claims, entering data into processing systems, and communicating trends. A background check is required, with a focus on compliance and process improvement within a collaborative team environment.