Claims Adjudicator

Immediate need for a talented Claims Adjudicator. This is a full time opportunity and is at Tampa, FL (Onsite). Please review the job description below and contact me ASAP if you are interested. 

Job ID: 26-06634
 
Pay Range: $18 - $19/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
  
Key Responsibilities

• Claims Adjudication: Review, verify, and process medical claims from start to finish, ensuring compliance with company policies and benefit guidelines.
• Documentation Analysis: Evaluate claim documents, medical records, and benefit summaries to determine eligibility.
• Communication: Interact with members, providers, and internal teams to resolve issues and gather missing information.
• Data Management: Enter claim details accurately into the claims system and maintain complete records.
• Problem Resolution: Investigate discrepancies and resolve disputes promptly.
• Adjustments: Handle rework and adjustments based on provider requests and internal requirements.

Key Requirements and Technology Experience: 

• Adjudication Expertise: Must have hands-on experience processing claims end-to-end
• Technical Skills: ICD-9 & ICD-10 coding; proficiency in Outlook, Word, and Excel
• Healthcare Knowledge: Familiarity with copay, coinsurance, deductible, and out-of-pocket terms.
• Government Programs: Understanding of Medicare and Medicaid eligibility and claims processing
• Preferred: Experience with CMS 1500 & UB forms; M\&R/Medicaid rework and adjustment claims.
•  Soft Skills: Excellent verbal and written communication; strong customer service orientation.

Our client is a leading IT Industry and we are currently interviewing to fill this and other similar fulltime positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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