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Adjustment Rep Jobs (NOW HIRING)

WGNSTAR

Adjustment Technician

Sparks, NV · On-site

The physical demands described above are representative of those that must be met by an employee to successfully perform the essential functions of this job. Additional Benefits: Paid Vacation ...

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How much do adjustment rep jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for adjustment rep in the United States is $20.39, according to ZipRecruiter salary data. Most workers in this role earn between $17.31 and $20.19 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as an Adjustment Representative, and why are they important?

To thrive as an Adjustment Representative, you need strong analytical skills, attention to detail, and a solid understanding of insurance or billing processes, typically supported by a high school diploma or relevant experience. Familiarity with claims management software, spreadsheets, and customer relationship management (CRM) systems is commonly required. Excellent communication, problem-solving, and negotiation skills help you resolve discrepancies and build positive client relationships. These abilities ensure accurate claim adjustments, regulatory compliance, and high levels of customer satisfaction.

What are some common challenges Adjustment Representatives face when handling complex claims, and how can they effectively manage them?

Adjustment Representatives often encounter challenges such as ambiguous documentation, tight deadlines, and navigating conflicting information from clients and providers. To manage these effectively, it's important to maintain strong organizational skills, communicate clearly with all parties involved, and stay current on company policies and industry regulations. Collaborating closely with team members and leveraging available resources, such as claim management software, can also help streamline the resolution process and ensure accuracy.

What is an Adjustment Rep?

An Adjustment Rep, or Adjustment Representative, is a professional who reviews and processes claims, typically in insurance or finance industries. They investigate discrepancies, verify documentation, and determine if adjustments are needed to correct billing errors or resolve disputes. Their role often involves communicating with customers, analyzing data, and ensuring compliance with company policies and regulations. Adjustment Reps play a crucial part in maintaining customer satisfaction by addressing and resolving issues efficiently.

What is the difference between Adjustment Rep vs Claims Processor?

AspectAdjustment RepClaims Processor
Required CredentialsHigh school diploma; insurance knowledgeHigh school diploma; insurance knowledge
Work EnvironmentOffice-based, insurance companiesOffice-based, insurance companies
Employer & IndustryInsurance providers, healthcareInsurance providers, healthcare
Common Search & ComparisonAdjustment Rep vs Claims Processor

Adjustment Representatives and Claims Processors both work within the insurance industry, often in similar office environments. They typically require comparable credentials, such as a high school diploma and insurance knowledge. The main difference lies in their specific roles: Adjustment Reps focus on reviewing and adjusting claims, while Claims Processors handle the initial processing of claims. Understanding these distinctions can help job seekers identify the right career path within insurance roles.

More about Adjustment Rep jobs
What job categories do people searching Adjustment Rep jobs look for? The top searched job categories for Adjustment Rep jobs are:
Adjustment Rep jobs near you
Consulting Actuary - ACA Risk Adjustment

Consulting Actuary - ACA Risk Adjustment

Blue Cross and Blue Shield of North Carolina

Charleston, SC

$143K - $229K/yr

Other

Medical, Dental, Vision, Retirement, PTO

Posted 5 days ago

Blue Cross and Blue Shield of North Carolina rating

7.8

Company rating: 7.8 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

165th of 260 rated insurance

Job description

Job Description

As a Consulting Actuary -ACA Risk Adjustment, you will play a pivotal role in delivering a wide array of actuarial and analytical services for our organization. Responsibilities include leading pricing strategies and actuarial initiatives for business segments, evaluating advanced care management models, conducting competitive benchmarking analyses, and designing and pricing sophisticated insurance products. You will support company objectives by providing reliable, actionable actuarial insights and recommendations, proactively identifying and addressing complex risks and opportunities. This position requires adaptability to the evolving landscape of the industry, ensuring our actuarial practices remain at the forefront of innovation and excellence.

What You'll Do

  • Accountable for completion of complex actuarial or analytical projects, ensuring timeliness, compliance, and quality of work

  • Provide proactive and strategic thought leadership of ways to improve processes, reduce risks, and meet department and enterprise objectives to achieve profitable growth and/or improve value, quality, and access for Blue Cross NC customers

  • Achieve segment financial targets and provide concise explanations of results and variances to expectations; act as a financial steward for the company

  • Communicate effectively with all levels and divisions within the organization, including Divisional Leadership

  • Manage external partnerships with vendors, auditors, regulators, and health care providers, including effective negotiation of contracts and/or rates

  • Develop and maintain strong business relationships with internal partners through business expertise and exceptional support; act as a strategic advisor

  • Meet continuing education standards required for job function, thought leadership and maintenance of actuarial credentials

What You Bring

  • Bachelor's degree or advanced degree (where required)

  • Member of the American Academy of Actuaries

  • Fellow of the Society of Actuaries

  • 7 years of relevant actuarial experience, related experience may be considered.

  • In lieu of an FSA, will consider candidates who are an Associate of the Society of Actuaries (ASA) and have at least 9 years of relevant actuarial experience.

Bonus Points

  • Deep experience with ACA Risk Adjustment, including HHS-HCC model methodology, risk score forecasting, and financial impact analysis - Highly Preferred

  • Proven expertise in ACA Risk Adjustment transfer forecasting and explanation of results to senior leadership - Highly Preferred

  • Strong understanding of diagnosis coding (ICD-10-CM), provider documentation practices, and their impact on risk adjustment outcomes.

  • Advanced analytical skills to identify risk adjustment leakage, emerging risks, and optimization opportunities across ACA populations

What You'll Get

  • The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community.

  • Work-life balance, flexibility, and the autonomy to do great work.

  • Medical, dental, and vision coverage along with numerous health and wellness programs.

  • Parental leave and support plus adoption and surrogacy assistance.

  • Career development programs and tuition reimbursement for continued education.

  • 401k match including an annual company contribution

  • Learn more

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$143,616.00 - $229,786.00

Skills

Actuarial Analysis, Actuarial Management, Actuarial Science, Actuarial Services, Affordable Care Act (ACA), Complex Care Management, Financial Reporting and Analysis, Hiring Management, Insurance Industry, Organizational Leadership, Regulatory Compliance

_____________________________________________________________________
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.

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