What are the responsibilities and job description for the Claims Adjudication Specialist position at Virtual?
Vaco is seeking a Claims Adjudication Specialist!
This role is designed to bridge the gap between claims processing and insurance payor operations. Remote. Bachelors and over 5 years of experience required.
The Claims Adjudication Specialist will ensure claims are processed accurately and efficiently, working between claims processing and insurance payor operations. This fully remote role requires minimal travel.
Key Responsibilities :
- Review claims from insurance companies to ensure they’re processed correctly and in compliance with regulations.
- Analyze claims data to spot issues, trends, or areas for improvement.
- Select appropriate sample sizes to evaluate claims and ensure accuracy.
- Work with internal and external teams to align claims with contractual agreements.
- Provide expertise on insurance payor systems and claims adjudication.
- Investigate and resolve claims that are improperly adjudicated.
- Stay current on healthcare regulations and payer requirements.
Qualifications :
Desired Competencies :
