Healthcare Claims Adjudication Specialist

MagnaCare; Las Vegas (NV); In loco; USD 40.000 - 54.000; Tempo pieno

Descrizione del lavoro

MagnaCare is seeking a detail-focused claims adjudicator to review and adjudicate non-standard reimbursement requests daily. You will apply healthcare contracts, medical terminology, and policies to ensure accurate outcomes while generating letters and questionnaires to obtain required information.

The role requires strong written and verbal communication, solid analytical skills, and the ability to manage multiple priorities.

Competenze

• Knowledge of healthcare contracts, medical terminology, and claims processing procedures.
• Experience with claims adjudication or medical billing is required.
• Ability to research and resolve complex claim issues with strong written and verbal communication.
• Proficiency in Office Suite to generate letters, questionnaires, and reports.

Mansioni

• Review and adjudicate reimbursement claims that fall outside auto adjudication standards daily.
• Apply medical policies, contractual provisions, and procedures to ensure precise adjudication.
• Generate correspondence and gather information from customers and providers; initiate phone inquiries as needed.
• Collaborate with Customer Service to resolve inquiries and concerns.
• Research and resolve client inquiries and escalations in a timely manner with internal teams.

Conoscenze

Claims processing

Medical terminology

Healthcare contracts

Analytical thinking

Written communication

Verbal communication

Multitasking

Problem solving

Quality focus

Timeliness

Attention to detail

Strumenti

Microsoft Word

Microsoft Excel

Descrizione del lavoro

MagnaCare is seeking a detail-focused claims adjudicator to review and adjudicate non-standard reimbursement requests daily. You will apply healthcare contracts, medical terminology, and policies to ensure accurate outcomes while generating letters and questionnaires to obtain required information.

The role requires strong written and verbal communication, solid analytical skills, and the ability to manage multiple priorities.