Medical Claims Specialist: Adjudication & Audit Expert

Insight Global; Portland (OR); On-site; USD 33,062 - 35,817; Full time

Job summary

Insight Global is seeking a Claims Processor to join a small team within a benefits organization in Portland, OR. The role supports U.S. Benefits, handling medical and dental claims, adjudication, auditing, and knowledge transfer.

You will process claims across the full lifecycle, review documentation, and ensure accuracy while communicating with members and providers. This position emphasizes high accuracy and independent work within a collaborative environment.

Qualifications

• Must-have: 2+ years of medical and/or dental claims processing experience.
• Experience with claims adjudication logic and appeals is a plus.
• Auditing claims and ensuring regulatory compliance experience preferred.
• Familiar with claims processing systems and configuration tools.
• Experience handling member/provider inquiries by phone and email.
• High attention to detail and ability to work independently.
• Comfortable working in a small team environment.
• Experience with reporting and data analysis related to claims.
• Coding or system configuration experience is desirable.
• Background in multi-employer trusts or benefits administration.
• Experience supporting process improvement initiatives.

Responsibilities

• Process medical and dental claims across the full lifecycle.
• Handle intake, review, data entry, validation, and adjudication.
• Perform follow-ups and issue resolution; final claims resolution.
• Audit claims processed by other team members for accuracy.
• Apply adjudication logic and plan rules accurately.
• Support claims system configuration and processing logic.
• Assist with reporting, data needs, and coding requirements.
• Respond to member/provider inquiries via phone and email.
• Collaborate with internal teams to ensure compliance and accuracy.
• Maintain detailed documentation and regulatory compliance.

Skills

Medical/dental claims processing

Adjudication logic

Auditing for compliance

Claims processing systems

Customer inquiries (phone/email)

Attention to detail

Small team environment

Reporting & data analysis

Coding / system configuration

Multi-employer trusts/benefits admin

Process improvement

Job description

Insight Global is seeking a Claims Processor to join a small team within a benefits organization in Portland, OR. The role supports U.S. Benefits, handling medical and dental claims, adjudication, auditing, and knowledge transfer.

You will process claims across the full lifecycle, review documentation, and ensure accuracy while communicating with members and providers. This position emphasizes high accuracy and independent work within a collaborative environment.