Remote Healthcare Claims Adjudicator

Wellcove CHCS Services; United States; Remote; USD 42,000 - 64,000; Full time

Job summary

Wellcove CHCS Services is seeking a detail-oriented claims adjudicator to manage outbound calls and adjudicate HP/AD claims. The role involves research, independent analysis of medical documents, and timely action within client guidelines.

Candidates should understand ICD-10, CPT, revenue codes, and HIPAA regulations, with strong English comprehension and math skills. You will work remotely with strict privacy and quality standards across the US.

Qualifications

• Experience with US HIP claims
• Strong medical terminology knowledge
• Ability to interpret medical documents and codes

Responsibilities

• Adjudicating HP/AD claims
• Handling all outbound calls
• Prioritize work and adjudicate claims within turnaround times
• Researching, reviewing, summarizing, and recommending actions on claims with appeals or grievances
• Comprehend medical reports using English, basic math and medical knowledge
• Ensure claims adjudication per client and company guidelines
• Respond to and resolve claims via email
• Calculate claim amounts for customers accurately
• Comply with HIPAA, confidentiality and privacy requirements

Skills

Medical terminology

English comprehension

Analytical skills

Attention to detail

Remote work capability

Education

Experience in US HIP claims

Tools

ICD-10

CPT

Revenue codes

Job description

Wellcove CHCS Services is seeking a detail-oriented claims adjudicator to manage outbound calls and adjudicate HP/AD claims. The role involves research, independent analysis of medical documents, and timely action within client guidelines.

Candidates should understand ICD-10, CPT, revenue codes, and HIPAA regulations, with strong English comprehension and math skills. You will work remotely with strict privacy and quality standards across the US.