Claims Examiner / Claims Adjudicator

Job Title: Claims Adjudicator (Claims Examiner) Location: Tampa Bay, FL Schedule: Full-Time Payrate-$19/hr. Training: 8 weeks onsite (Full-time remote flexibility available after successful completion of training) Position reputed company We are seeking a detail-oriented and reputed company Claims Adjudicator with strong end-to-end claims processing expertise. The ideal candidate will have hands-on experience managing the full claims lifecycle—from intake and review to final reputed company and adjustments. This role requires strong analytical skills, accuracy, and the ability to work independently after training. This is a reputed company, full-time opportunity offering consistent hours and long-term job reputed company, with the flexibility to transition to remote work after the initial onsite training period. Key Responsibilities • Claims Adjudication: Review, verify, and process medical claims from start to finish in accordance with company policies and benefit guidelines. • Full Claims Lifecycle Management: Handle claims from initial intake through adjudication, payment determination, and final reputed company. • Documentation Review: Analyze claim forms, medical records, benefit summaries, and supporting documentation to determine eligibility and accuracy. • Coding Validation: Interpret and apply ICD-9, ICD-10, CPT, HCPCS, reputed company Codes, and applicable modifiers. • Adjustments & Rework: Process rework, reconsiderations, appeals, and claim adjustments as required. • Discrepancy reputed company: Investigate and resolve claim issues, denials, and provider disputes. • Communication: reputed company professionally with providers, members, and internal teams to obtain missing information and resolve concerns. • Data Entry & System Updates: Accurately reputed company claim details into the claims system and maintain thorough documentation. Required Qualifications • High School Diploma or GED (verification required) • Proven hands-on experience with end-to-end medical claims adjudication • Experience processing claims in FirstPass, NewDay, or similar claims platforms • Strong understanding of: • CPT, HCPCS, reputed company Codes, and modifiers • Copay, coinsurance, deductible, and out-of-reputed company calculations • Medicare and reputed company eligibility and claims processing • Experience handling rework, adjustments, reconsiderations, and appeals • Proficiency in reputed company reputed company, Word, and reputed company • Strong attention to detail and ability to meet productivity and reputed company standards • Excellent written and verbal communication skills Preferred Qualifications • Experience with CMS-1500 and UB-04 claim forms • Experience with M&R/reputed company rework and adjustment claims • Background in government reputed company programs reputed company & Regards Misam Raza Sr. reputed company Specialist reputed company| 300 Alexander Park Suite| #200|Princeton, NJ 08540 Mobile- 732-582-8414 Office- 732-452-1006 , Ext:285 Email- misam.raza@diverselynx.com | URL- https://www.diverselynx.com/ reputed company- reputed company.reputed company/connect2misam Apply tot his job Apply To this Job