Job Description
Job DescriptionBishop & Company is recruiting for a Claims Adjudicator for a health insurance provider in Honolulu, HI. Previous experience within healthcare administration and/or claims preferred.
Claims Adjudicator
Overview:
The Claims Adjudicator analyzes claims to determine the extent of the health plan’s liability and makes benefit determinations on claims in accordance with plan benefits, processing guidelines, and policy provisions.
Responsibilities:
- Processes claims according to health plan documents while applying Company policies and procedures.
- Verifies data entered from the claim form is accurate and complete to enable correct processing.
- Prioritizes workload to ensure performance objectives and competencies are met or exceeded.
- Accesses and utilizes all available resources to perform required functions.
- Improves claim payment accuracy by identifying pricing and/or submission inconsistencies and reporting them to management.
- Performs duties with productivity and accuracy levels set by management, reflective of the types and complexity of claims processed.
- Ensures that Federal and State regulations, timeliness standards, confidentiality requirements, and accreditation standards are met.
- Runs third-party liability (TPL) reports and other claim reports.
- Efficiently processes the following types of claims:
- Professional claims
- TPL claims
- Previously denied claims
- Travel reimbursements
- Dental claims
- Basic Coordination of Benefits (COB)
Qualifications:
- High school diploma or GED required.
- Certificate from college or technical school; experience in medical claims processing at a health insurance company or third-party administrator; or an equivalent combination of education and experience is preferred.
- One (1) year customer service experience or clerical experience in a healthcare related setting.
- Work independently and in a team environment.
- Certified Professional Coder (CPC) certification is preferred.
- Basic-level proficiency in Microsoft Word and Excel required.
- Knowledge of medical terminology, CPT, ICD, and HCPCS codes required.
- 10-key by touch required.
- Strong data entry skills and attention to detail.
Additional Information:
- Job Type: Temp-to-hire opportunity
- Pay: $17.70/hr - $21.63/hr., commensurate with experience
- Location: Honolulu, HI 96813
- Parking: Not provided
- Schedule: Full time (40 hours/week), Monday – Friday, 8:00 AM – 5:00 PM
- Benefits: Bishop & Company offers its temporary and contract employees attractive, competitive benefits, including paid holidays, paid vacation, health insurance, and matching 401k plan for all those who qualify!
Bishop & Company provides recruiting and placement services for client companies and opportunities for job seekers throughout Hawaii. We charge no fees to candidates and our client services are 100% guaranteed.
Please forward resumes to:
Bishop & Company
Phone: 808-839-2200
Website: http://www.bishopco.net/
Location: Honolulu, HI
***No relocation, In-state applicants only. Must be available to interview immediately.***
Equal Opportunity Employer – Disability and Veteran