Claims Adjudicator – Medical Accounts (Pooling)

Role

We are pooling qualified applicants in preparation for anticipated openings in the second and third quarters.

We are in the business of paying claims- your role is to help us uphold this promise.

The Claims Adjudicator is responsible for evaluating and processing claims from policy holders, hospitals, laboratories, and clinics. This role ensures that our clients and accredited facility partners receive their service payments based on approved limits that they are entitled to- while maintaining accuracy, compliance, and efficiency in claims processing.

• Level: R&F - Specialist

Responsibilities

• Claims Processing & Approval: Assess and process claims from reimbursement or medical facilities, ensuring they align with policy coverage and benefit limits. Compute overall utilization and approve claims within assigned authority levels.

• Document Review & Verification: Examine sup...