Claim Examiner Adjudication Job Description
As a Claim Examiner Adjudication, you will be responsible for reviewing, analyzing, and adjudicating insurance claims to make accurate decisions on coverage and payment. You will collaborate with providers and policyholders to resolve claim issues and ensure timely processing.
Responsibilities
- Reviewing and analyzing insurance claims for accuracy and completeness
- Adjudicating claims based on policy terms, regulations, and guidelines
- Communicating and collaborating with providers and policyholders to resolve claim issues
- Ensuring compliance with industry regulations and company policies
- Maintaining accurate claim records and documentation
Qualifications
- Bachelor's degree in Healthcare Administration, Business, or related field
- Proven experience in insurance claims processing and adjudication
- Knowledge of healthcare billing codes, insurance policies, and regulations
- Strong attention to detail and analytical skills
- Excellent communication and problem-solving abilities
Skills
- Knowledge of ICD-10 and CPT coding
- Proficiency in using claims processing software
- Strong data analysis and decision-making skills
- Ability to prioritize and manage multiple tasks
- Excellent communication and negotiation skills