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AblePay Health LLC

Claims Adjudicator

Entry-Level JobVerifiedNo experience needed

Career Insights for Medical Claims Processor / Representative

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Based on Pennsylvania data

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What they do

A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.

$42,879 / year median in Pennsylvania

-5% projected decline

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Job Description

Claims Adjudicator AblePay Health LLC Allentown, PA Job Details Full-time 1 day ago Qualifications Data integrity assurance Insurance claims inquiry response Healthcare dispute resolution Patient question and concern management Insurance claims settlement negotiation Data validation techniques Insurance dispute resolution Client rapport building Health insurance customer support Claims negotiation Financial issue resolution Data integrity and documentation Health information data integrity Policy verification in claims processing Relationship management Billing issue inquiries Claims documentation management Negotiated pricing Entry level Full Job Description The Claims Adjudicator position is responsible for assuring claims received from billing providers are evaluated for data integrity and validating the Patient Responsibility before processing to the secure Member Portal; building and maintaining outstanding relationships with providers.
Job Duties/Essential Functions:
Processes electronic and paper claims on a daily basis. Verifies and reviews claims received are accurate before adjudication. Reviews and resolves claim discrepancies in a timely manner. Contacts billing providers to correct AblePay Member ID and insurance information as needed. Establishes a working relationship with billing providers, Members, and internal staff. Assists Members on any related dispute/issue as authorized. Assists Members with general billing questions. Contacts medical providers to negotiate the greatest discount/savings on out of network claims. Performs other related duties as assigned by management.