Job Description

Claims Payment Adjuster

Seeking a detail-oriented and analytical Claims Payment Adjuster to join our team. In this role, you will be responsible for reviewing, processing, analyzing and adjusting medical claims to ensure accuracy, compliance, and efficiency. You will work closely with other team members and cross functional teams such as configuration and Account Management to resolve discrepancies and improve claims processing workflows.

Key Responsibilities:

• Process and analyze medical claims in accordance with company policies within all client service level agreements.
• Consistently meet department quality and production standards.
• Review claims for accuracy, completeness, and compliance with Medical Policy and client unique set up. Identify and investigate claim discrepancies, denials, and errors, and take action to report issues internally.
• Communicate with other plans via the BlueSquared BCBSA Application. Maintain up-to-date knowledge of processing and continue to increase skill set in order to handle more complex claim scenarios.
• Provide insights to improve claims processing efficiency. Collaborate with internal teams to enhance claims handling procedures.
• Other duties as assigned by Leadership Team.

Qualifications & Skills:

Experience: 3 years or more of experience in medical claims processing and adjusting or healthcare administration. Preferred experience with pre-existing condition reviews.

• Technical Skills: Knowledge of medical billing codes (ICD-10, CPT, HCPCS), HealthRules, FOS, Salesforce and the BlueCard product.
• Analytical Skills: Ability to assess claim data and identify errors or inefficiencies. Possess excellent mathematical skills and have the ability to work independently and within tight timeframes. Exposure to preexisting provisions is a plus
• Communication Skills: Strong written and verbal communication skills for interacting with various stakeholders.
• Attention to Detail: High level of accuracy and thoroughness in reviewing claims for client.

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

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