Claims Adjuster

Position Overview:

Key Responsibilities:

• Review and adjudicate

  medical claims

  based on payer policies and contract agreements.
• Validate

  eligibility, coverage, and benefits

  before processing claims.
• Assess

  CPT, ICD-10, HCPCS codes, and modifiers

  to ensure proper reimbursement.
• Identify and resolve

  discrepancies, errors, and claims denials

  .
• Ensure compliance with

  HIPAA, CMS, and payer regulations

  .
• Work closely with

  providers, internal teams, and payers

  to resolve claim issues.
• Meet productivity, accuracy, and turnaround time standards.

Must-Have Skills:

• Strong knowledge of

  claims processing, payer guidelines, and medical coding

  .
• Experience with Facet Tool.
• Familiarity with

  EOBs, ERAs, and adjudication policies

  .
• Excellent analytical and problem-solving skills.
• Attention to detail and ability to work in a fast-paced environment.

Educational Qualification:

• Education:

  Any graduate (Healthcare, Commerce, or related fields preferred)

• Experience

  : 1-3 years in

  claims adjudication, medical claims processing, or US healthcare payer operations