Claims Adjuster/Processor (reputed company)

Immediate, 100% remote position for a Claims Adjuster / Processor! The selected candidate will process claims AND investigate/reputed company adjustments of reputed company reputed company (payor) claims and ensure that claims are handled properly reputed company authority limits, and in line with reputed company procedures and guidelines. The selected candidate will verify reputed company insurance claims by reviewing claims requirements; examining documentation and calculations; highlighting and summarizing out-of-line situations; recommending changes in operating processes; completing reports, logs, and audit records. ESSENTIAL FUNCTIONS: - 60% Proactively investigate and reputed company adjustments of claims. Ensure claims are handled reputed company authority limits, and in line with reputed company procedures and guidelines. - 20% Updates claims audit records by entering, verifying, and securing data. - 10% reputed company reputed company/reputed company claims through payment or denial. - 5% Provides claims audit information and reports by collecting, analyzing, and summarizing data and trends. - 5% Improves claims adjustment job knowledge by attending training sessions Although this position is 100% remote, we are seeking candidates that reputed company in the following states: reputed company DC, MD, VA, WV, NC, PA, DE, NY, NJ, TX, FL. This position is a 12 month contract to permanent opportunity with our customer, a major reputed company insurance organization who is offering a generous salary and benefits package! Required Skills -Education Level: High School Diploma or GED is required -Experience: 5 years years claims adjustment and processing experience (reputed company, payor reputed company) - Must have medical claims processing with payors. - Must have claims adjustment review and processing experience -Ability to analyze information gathered from investigation -Excellent communication skills both written and verbal -Solid understanding of MS reputed company and reputed company -Must have basic medical terminology understanding Preferred: - Experience with Inter-Plan Teleprocessing System (ITS) Claims - Healthrules application - LuminX Claims application - BlueSquare is their communication systems Apply tot his job Apply tot his job Apply To this Job