WFH Claim Adjustment

Remote, USA Full-time Posted 2025-07-04

Job Title: Claim Adjustment
Duration: 11+ Months
Location: 100% Remote
Client laptop
BGV must be cleared to start

Job Description

Knows how to review HCFA 1500 and UB04 processing (not mandatory)
Facets experience is a plus (not mandatory)
Working on multiple screens, hand-on with claims processing

Claims Adjudication / Adjustment
Knows how to review HCFA 1500 and UB04 processing (not mandatory).
Facets experience is a plus (not mandatory)
Working on multiple screens, hand-on with claims processing
Review and scrutinize claims and process claims into the computer system as per the provided DLPs /guidelines
Determine accurate claims payment or denial, identify, and elevate dubious claims or system issues to process the claim accurately.
Process claims in a timely manner, as per the required TAT
Correct errors or omissions on claim and investigate questionable data
To maintain Quality as per the SLA
To maintain Productivity as per the SLA
Continuously meet and exceed the assigned Targets
Performance should be maintained in accordance with the process performance parameters
To maintain confidentiality of work done
To follow all regulatory requirements and procedures as per the company policy
Display high levels of professionalism in the work delivered and overall conduct

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WFH Claim Adjustment

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