Medical Claims Adjuster

Group Administrators is a trusted Third-Party Administrator (TPA) approaching 40 years of experience providing comprehensive administrative services for self-funded health insurance plans. We handle all aspects of claims processing in-house, ensuring that every claim is managed with precision and efficiency. As we continue to grow, we’re looking to expand our team with motivated, detail-oriented professionals who are committed to excellence.

Position Overview:
We are seeking an experienced Claims Adjuster to join our dynamic team. In this role, you will be responsible for reviewing, analyzing, and processing medical claims to ensure accuracy and compliance with policy guidelines. Your expertise will be critical in determining claim resolutions and maintaining positive relationships with healthcare providers, insurance companies, and policyholders. The ideal candidate will possess strong knowledge of medical billing and coding practices, as well as a commitment to accuracy and customer service.

Key Responsibilities:

• Review and assess medical claims for accuracy, completeness, and compliance with policy terms.
• Determine appropriate payment or denial of claims based on medical policy guidelines and contract terms.
• Verify medical coding, billing information, and supporting documentation for compliance with CPT and ICD-10 standards.
• Investigate, analyze, and resolve discrepancies, errors, or issues related to claims processing.
• Collaborate with healthcare providers, insurance carriers, and policyholders to provide claim status updates and resolve inquiries.
• Maintain accurate records of all claims processing activities in compliance with company policies and regulatory requirements.
• Continuously improve claims processing efficiency and contribute to the development of best practices.

Required Experience and Qualifications:

• Minimum of 2 years of experience in medical claims examination, claims adjusting, or a related field.
• Proficiency with medical claims processing systems and insurance software.
• Strong understanding of medical office procedures, terminology, and industry standards.
• Solid knowledge of CPT and ICD-10 coding for accurate claims processing and medical billing.
• Exceptional attention to detail and ability to accurately interpret medical documentation.
• Excellent communication and problem-solving skills, with the ability to resolve complex claims issues efficiently.
• Strong organizational skills and the ability to manage multiple tasks in a fast-paced environment.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to Relocate:

• Schaumburg, IL 60173: Relocate before starting work (Required)

Work Location: In person