Claims Adjudicator

$40,000 - $50,000 yearly

Job Category:Administrative

Position Type:Direct Hire / Permanent

Work Model:Hybrid

Location:Naperville, Illinois  [Hybrid]

Job ID:131508

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Job Description

We are actively seeking an experienced and detail-oriented Claims Adjudicator to join this dedicated healthcare team. As a Claims Adjudicator, you will be responsible for processing and reviewing medical insurance claims, utilizing your in-depth knowledge and expertise in medical claim adjudication. 

Claims Adjudicator responsibilities: 

  • Review and adjudicate medical insurance claims in accordance with benefit plans, policies and industry regulations 

  • Utilize working knowledge of benefit plans to interpret limitations, exclusions and schedules of benefits 

  • Apply expertise in subrogation processes and collaborate with relevant stakeholders to ensure accurate claims processing 

  • Conduct eligibility verification and coordinate benefits to facilitate seamless claims adjudication 

  • Demonstrate proficiency in medical coding, including knowledge of medical terminology, ICD-10 and Current Procedural Technology (CPT) codes 

  • Investigate and resolve discrepancies or issues related to claims submissions 

  • Communicate effectively with healthcare providers, insurance companies, and internal teams to obtain necessary information and clarification 

Claims Adjudicator Requirements: 

  • Minimum of 3-5 years of direct experience in a medical claim adjudication environment 

  • Working knowledge and experience in interpreting benefit plans, including an understanding of limitations, exclusions and schedules of benefits 

  • Strong experience in subrogation and related processes 

  • Proficient in eligibility verification, medical coding, coordination of benefits and subrogation 

  • Familiarity with medical terminology, ICD-10, and Current Procedural Technology (CPT) codes 

  • Excellent analytical and problem-solving skills 

  • Effective communication and interpersonal skills 

  • Ability to work efficiently in a fast-paced environment 

If you are a seasoned professional with a proven track record in Claims Adjudication and meet the above requirements, we invite you to apply for this position. 

Thank you, 

Anna White 

Sr. Project Manager - Heallthcare Revenue Cycle 

LaSalle Network 

LaSalle Network is an Equal Opportunity Employer m/f/d/v.

LaSalle Network is the leading provider of direct hire and temporary staffing services. For over two decades, LaSalle has helped organizations hire faster and connect top talent with opportunities, from entry-level positions to the C-suite. With units specializing in Accounting and Finance, Administrative, Marketing, Technology, Supply chain, Healthcare Revenue Cycle, Call Center, Human Resources and Executive Search. LaSalle offers staffing and recruiting solutions to companies of all sizes and across all industries. LaSalle Network is the premier staffing and recruiting firm, earning over 100 culture, revenue and industry-based awards from major publications and having its company experts regularly contribute insights on retention strategies, hiring trends and hiring challenges, and more to national news outlets.