Healthcare Claims Adjudicator - Aurora, IL area candidates ONLY

RJI Search; United States; On-site; USD 49,000 - 93,000; Full time

Job summary

A prominent healthcare organization is seeking a Claims Adjudicator II who will be responsible for reviewing, verifying, and adjudicating claims to ensure accuracy and compliance with established guidelines. The position requires a minimum of 3-5 years of experience in a medical claim adjudication setting. Join a dynamic team that values quality work and offers substantial benefits, including healthcare, retirement plans, and tuition assistance.

Benefits

Medical

Dental

Vision

Paid Time-Off (PTO)

401(k)

Pension Plan

Short- & Long-term Disability

Life insurance

Tuition Assistance

Employee Assistance Program (EAP)

Qualifications

• 3-5 years of direct experience in a medical claim adjudication environment.
• Working knowledge and experience interpreting benefit plans.
• Experience with medical coding and related processes.

Responsibilities

• Review and adjudicate claims within established timeframes.
• Determine eligibility status and request additional documentation if necessary.
• Adjudicate claims according to established productivity and quality goals.

Skills

Medical terminology

ICD10

Current Procedural Technology (CPT)

Eligibility verification

Medical coding

Coordination of benefits

Job description

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Aurora, IL, US - onsite training for 3 weeks, then fully remote. MUST be local to the Aurora, IL area.

The Claims Adjudicator II position will receive, examine, verify and input submitted claim data, determine eligibility status, and review and adjudicate claims within established timeframes.

DUTIES

• Screens claims for completeness of necessary information
• Interprets the plan benefits from the Summary Plan Description (SPD)/Plan Documents
• Codes basic information and selects codes to determine payment liability amount
• Evaluates diagnoses, procedures, services, and other submitted data to determine the need for further investigation in relation to benefit requirements, accuracy of the claim filed, and the appropriateness or frequency of care rendered
• Determines the need for additional information or documentation from participants, employers, providers and other insurance carriers
• Handles the end to end process of Medicare Secondary Payer (MSP) files
• Requests overpayment refunds, maintains corresponding files and performs follow-up actions
• Handles verbal and written inquiries received from internal and external customers
• Adjudicates claims according to established productivity and quality goals
• Achieve individual established goals in order to meet or exceed departmental metrics

QUALIFICATIONS

• 3 ~ 5 years of direct experience minimum in a medical claim adjudication environment (on the payor side/insurance side)
• Working knowledge and experience in interpretation of benefit plans, including an understanding of limitations, exclusions, and schedule of benefits
• Experience with eligibility verification, medical coding, coordination of benefits, and subrogation and it’s related processes
• Experience with medical terminology, ICD10 and Current Procedural Technology (CPT) codes

We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), AND Pension Plan, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Full-time

Job function

• Job function

  General Business

• Industries

  Hospitals and Health Care and Insurance

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Inferred from the description for this job

Medical insurance

Vision insurance

401(k)

Pension plan

Paid maternity leave

Paid paternity leave

Tuition assistance

Disability insurance

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