HealthCare Claims Adjudicator/Claims Examiner

Job Description Evaluate and process various types of claims, including facility, professional, inpatient, and outpatient services.
Adhere to claims adjudication rules to ensure compliance with CMS regulations and internal standards.
Review Medicare, Medicaid, and Commercial services to ensure contract adherence and timely processing.
Authorize claim payments within established limits; escalate to Claims Manager as needed.
Handle refunds, appeals, disputes, and adjustments where applicable.
Identify opportunities for process improvements and recommend system enhancements within the claims department.
Undertake additional responsibilities as assigned.
Education: High School Diploma or equivalent required.
Experience: Preferred minimum of one year working closely with healthcare claims or in a claims processing/adjudication environment. Training provided for candidates without experience.
Technical Skills / Knowledge: Understanding of health claims processing and adjudication.
Ability to perform basic to intermediate mathematical computations.
Familiarity with medical terminology, particularly ICD-9 & ICD-10.
Basic proficiency in MS Office applications.
Ability to work independently as well as collaboratively in a team.
Strong time management, written, and verbal communication skills.
Attention to detail and sound decision-making abilities.
Salary: $16.00 - $20.00 per hour based on experience. Job Type: Full-time Benefits: Dental insurance
Health insurance
Vision insurance
Performance bonus
Referral bonus
Schedule: 8-hour shifts, Monday to Friday
Flexible scheduling available
Work Location: Hybrid remote in Tampa, FL 33609
Employment Type: Temporary
Salary: $ 16.00 20.00 Per Hour