Job Description

About the Company

Our client is a leading value-based care and managed service organization that partners with independent providers to drive transformative change in healthcare. This role is fully remote and part of a growing national team.

About the Role

The Claims Adjudicator will play a key role in supporting critical aspects of claims examination, focusing on authorization matching, duplicate claim identification, and adjudication of BCBS HMO claims. This production-based position is designed to help reduce a significant claims backlog while ensuring accuracy and compliance with guidelines.

Responsibilities

• Approve or deny claims for payment by verifying proper authorizations and resolving system hold codes
• Review claims against established criteria (dates, codes, etc.) to authorize payment
• Identify duplicate claims and support denial processes during adjudication
• Coordinate benefits and payments between multiple insurance companies (COB savings)
• Investigate and resolve claims issues from Customer Service inquiries
• Analyze recurring provider or member issues, recommend solutions to management
• Provide feedback to update standard operating procedures
• Maintain HIPAA compliance regarding patient privacy
• Contribute to team goals and productivity standards

Qualifications

• 2+ years of medical claims processing experience (BCBS HMO preferred)
• Experience working with UB04 and CMS-1500 claim forms
• Strong understanding of claims adjudication steps and denial management
• Production-focused and comfortable working independently
• Proficient in Microsoft Office (Outlook, Teams, Word, Excel)
• Prior experience with EZCap claims software preferred
• Availability to work an 8-hour shift between 7:00 AM – 6:00 PM CST

Required Skills

• Medical claims processing experience
• Understanding of claims adjudication
• Proficiency in Microsoft Office

Preferred Skills

• Experience with BCBS HMO
• Familiarity with UB04 and CMS-1500 forms
• Experience with EZCap claims software

Pay range and compensation package

Pay: $25 – $28 / hour (depending on experience)

Benefits: Dental, Vision, Medical, 401k

Equal Opportunity Statement

Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.

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