Healthcare Claims Adjuster I

Healthcare Claims Adjuster I

Job Title :

Healthcare Claims Adjuster ILocation:

Baltimore, Maryland (meetings and tranings)

Type:

Contract To HireCompensation:

$25/

HRContractor Work Model:

80% Remote (must reside in D.C., MD, or VA per client)About the RoleWe are looking for a detail-oriented and proactive Claims Adjuster to join our team. In this role, you'll investigate, evaluate, and resolve insurance claims while ensuring accuracy, compliance, and a positive experience for all stakeholders. If you enjoy problem-solving, analyzing information, and working in a fast-paced environment, this could be a great fit.

What You'll Do

• Investigate & Evaluate Claims
• Review and assess claims to determine validity and coverage
• Analyze documentation, calculations, and supporting data
• Ensure claims are handled within authority limits and in accordance with company policies and procedures
• Identify and flag exceptions or unusual situations
• Maintain Accurate Records
• Update and maintain claims systems and audit records
• Enter, verify, and secure claim-related data with a high level of accuracy
• Resolve Claims
• Process claim settlements through payment or denial
• Handle both standard and moderately complex claims
• Reporting & Analysis
• Prepare reports by collecting, analyzing, and summarizing claims data and trends
• Support audit and compliance activities
• Continuous Improvement
• Attend training sessions to stay up to date on industry regulations, tools, and best practices
• Contribute ideas to improve claims processes and efficiencyWhat You BringEducation
• High School Diploma or GED requiredExperience
• 3+ years of claims adjusting experience
• Strong understanding of claims systems, policies, and proceduresPreferred Experience
• Medical claims processing and adjustment
• Familiarity with
• Medical terminology
• Provider refunds
• Subrogation
• Workers' Compensation
• Claims disbursementsSystem One, and its subsidiaries including Joulé and Mountain Ltd.

, are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.#M-1#LI-AJ1

Ref:

#851-Rockville-S1System One, and its subsidiaries including Joulé, ALTA IT Services, CM Access, TPGS, and MOUNTAIN, LTD., are leaders in delivering workforce solutions and integrated services across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible full-time employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.