Job Title: Claims Adjudicator

Job Summary:
We are seeking a skilled Claims Adjudicator to join our team. As a Claims Adjudicator, you will be responsible for reviewing and adjudicating complex or specialty claims, ensuring they are processed accurately and efficiently. You will play a vital role in determining whether to return, deny, or pay claims in accordance with organizational policies and procedures. Additionally, you will have the opportunity to mentor and train new staff members, contributing to their professional growth and development. If you have a strong attention to detail, excellent communication skills, and a background in claims processing, we encourage you to apply.

Job Specifications:
– Job Type: Full-time
– Location:4101 Percival Road, Columbia SC
– Pay Rate: $13-14.00/hr
– Shift: Monday – Friday 8-4:30p

Roles and Responsibilities:
– Review and adjudicate complex or specialty claims, following organizational policies and procedures.
– Determine whether to return, deny, or pay claims, ensuring compliance with business/contract regulations and internal standards.
– Assist in training and mentoring new staff members to ensure their successful integration into the team.
– Enter claims into the system after verifying the correct coding of procedures and diagnosis codes.
– Verify the accuracy of claims data entry and correct any processing errors by reprocessing, adjusting, and/or recouping claims.
– Research and resolve claims edits and deferrals by utilizing policies, procedures, reference materials, and coordination with internal support areas.
– Respond to routine correspondence and complete spreadsheets as necessary.

Qualifications & Skills:
– High School Diploma or equivalent is required.
– Minimum of 2 years of experience processing, researching, and adjudicating claims.
– Strong organizational, analytical, and judgment skills.
– Excellent oral and written communication skills.
– Proficiency in spelling, punctuation, and grammar.
– Proficient in basic business math.
– Ability to handle confidential or sensitive information with discretion.
– Proficiency in Microsoft Office.
– Preferred skills include strong time management skills, knowledge of mathematical and statistical concepts, and proficiency in word processing, spreadsheet, and database applications.

Opportunities:
– Opportunity to work in a dynamic and collaborative team environment.
– Chance to develop and refine your skills in claims adjudication.
– Potential for career growth and advancement within the organization.
– Exposure to a variety of complex and specialty claims.
– Competitive salary based on experience.

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