Senior Claims Adjudicator – Complex & Specialty

CGS Administrators; Nashville (TN); Presencial; USD 45.000 - 60.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

401k with company match

Paid Time Off

Education Assistance

Descripción de la vacante

CGS Administrators in Nashville, TN is seeking a claims adjudicator to review and adjudicate complex or specialty claims. The role involves processing claims per regulations, verifying coding accuracy, and maintaining quality standards.

The position is full-time in an office setting with typical business hours. Ideal candidates will have a High School Diploma and at least 2 years of claims processing experience, strong organizational and communication skills, and proficiency in Microsoft Office.

Formación

• High school diploma or equivalent required.
• 2 years of experience processing, researching and adjudicating claims.

Responsabilidades

• Review and adjudicate complex or specialty claims per policies.
• Enter claims into system after verifying coding accuracy.
• Verify that claims are correctly keyed.
• Ensure processing aligns with quality and production standards.
• Correct processing errors by reprocessing or recouping claims.
• Research claim edits and deferrals; coordinate with internal teams.
• Respond to routine correspondence and maintain records.

Conocimientos

Organizational skills

Analytical thinking

Judgment

Communication skills

Educación

High School Diploma

Herramientas

Microsoft Office

Descripción del empleo

CGS Administrators in Nashville, TN is seeking a claims adjudicator to review and adjudicate complex or specialty claims. The role involves processing claims per regulations, verifying coding accuracy, and maintaining quality standards.

The position is full-time in an office setting with typical business hours. Ideal candidates will have a High School Diploma and at least 2 years of claims processing experience, strong organizational and communication skills, and proficiency in Microsoft Office.