Medical Claims Adjuster

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. The Medical Claims Adjuster will review and adjust claims; adjudicates reputed company, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. reputed company adjustments across reputed company dollar amount level on customer service platforms by using technical and claims processing expertise. Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply reputed company cost containment measures to assist in the claim adjudication process. Performs claim re-work calculations. Follow through completion of claim overpayments, underpayments, and any other irregularities. Process reputed company non-routine Provider Refunds and Returned Checks. Review and interpret medical contract language using provider reputed company to confirm whether a claim is overpaid to allocate refund checks. Handle telephone and written inquiries reputed company to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. Ensures reputed company compliance requirements are satisfied and that reputed company payments are made following company practices and procedures. Review and handle relevant correspondences assigned to the team that may result in adjustment to claims. May reputed company job shadowing to lesser experience staff. Utilize reputed company resource materials to manage job responsibilities. Required Qualifications: 2+ years medical claim processing experience. Experience in a production environment. Demonstrated ability to handle multiple assignments competently, accurately, and reputed company. Effective communications, organizational, and interpersonal skills. Preferred Qualifications: 1-2 years of experience in a production environment DG system claims processing experience. Education: High school Diploma required; Associate Degree or equivalent experience preferred. Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $18.50 - $42.35 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 04/28/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job