Remote Healthcare Claims Adjudicator

B Capital; Buffalo (NY); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Remote work

Job summary

Centivo, headquartered in Buffalo, NY, is seeking a Claims Adjustor to manage and adjudicate healthcare claims for self-funded employer groups. Training begins in October 2026, with advanced roles available as experience grows.

The position involves reviewing claims, applying SPD rules, and coordinating with several internal teams to ensure timely and accurate payments. The role requires knowledge of healthcare claims, medical coding, and the ability to work independently in a fast-paced

Qualifications

• Experience with a highly automated and integrated claims processing system.
• Knowledgeable about health care claims, medical coding, and benefit plan rules.
• Strong communication skills and ability to work with minimal supervision.

Responsibilities

• Adjudicate claims in assigned work queues following Policies, SPD terms, and client requirements.
• Review system-generated edits to ensure benefits are applied correctly according to SPD and client funds.
• Escalate interpretation issues to Plan Build/System Configuration Team as needed.
• Route unresolved edits to Provider Maintenance or Pricing teams for resolution.
• Deny claims when data is missing and generate explanatory correspondence; re-adjudicate when data is received.
• Maintain daily, weekly, and monthly production levels per department policies.

Skills

Claims processing

Healthcare knowledge

Microsoft Office

Analytical thinking

Communication skills

Education

High School diploma or GED

Tools

HealthRules Payer

Claims processing software

Job description

Centivo, headquartered in Buffalo, NY, is seeking a Claims Adjustor to manage and adjudicate healthcare claims for self-funded employer groups. Training begins in October 2026, with advanced roles available as experience grows.

The position involves reviewing claims, applying SPD rules, and coordinating with several internal teams to ensure timely and accurate payments. The role requires knowledge of healthcare claims, medical coding, and the ability to work independently in a fast-paced