Processor, Claims I
$17.50 - $22/hr
FULL TIME REMOTE PURPOSE: Under direct supervision, reviews and adjudicates paper/electronic claims. Determines proper handling and adjudication of claims following organizational policies and ...
Processor, Claims I
$17.50 - $22/hr
FULL TIME REMOTE PURPOSE: Under direct supervision, reviews and adjudicates paper/electronic claims. Determines proper handling and adjudication of claims following organizational policies and ...
Manager, Configuration - Claims Adjudication/Custom Solutions - Remote
Long Beach, CA · On-site +1
$72K - $156K/yr
Job Summary Leads and manages team responsible for configuration activities including accurate and timely implementation and maintenance of critical information on claims databases, validation of ...
Manager, Configuration - Claims Adjudication/Custom Solutions - Remote
Long Beach, CA · On-site +1
$72K - $156K/yr
Job Summary Leads and manages team responsible for configuration activities including accurate and timely implementation and maintenance of critical information on claims databases, validation of ...
Insurance Specialist - Fully Remote | Upto $1450 Part-time
New York, NY · Remote
$1.1K - $1.4K/wk
Remote Role Responsibilities * Review and evaluate AI-generated outputs related to plan benefit ... adjudication, and medical necessity criteria. * Create realistic scenarios based on health ...
Quick apply
Insurance Specialist - Fully Remote | Upto $1450 Part-time
New York, NY · Remote
$1.1K - $1.4K/wk
Remote Role Responsibilities * Review and evaluate AI-generated outputs related to plan benefit ... adjudication, and medical necessity criteria. * Create realistic scenarios based on health ...
Partners with multiple business units and teams to ensure the accuracy of claims adjudication ... Remote work options * Generous Paid-Time Off * Annual Reviews and Development Plans * Retirement ...
Quick apply
Partners with multiple business units and teams to ensure the accuracy of claims adjudication ... Remote work options * Generous Paid-Time Off * Annual Reviews and Development Plans * Retirement ...
Data Scientist (Remote)
Arlington, VA · On-site +1
Washington DC Metro Area - Remote (candidates MUST BE located in the National Capital Region - DMV) Clearance Required: a TS or CBP BI or DHS Suitability clearance adjudicated within the past 4 years ...
Data Scientist (Remote)
Arlington, VA · On-site +1
Washington DC Metro Area - Remote (candidates MUST BE located in the National Capital Region - DMV) Clearance Required: a TS or CBP BI or DHS Suitability clearance adjudicated within the past 4 years ...
Data Scientist (Remote)
Arlington, VA · On-site +1
Washington DC Metro Area - Remote (candidates MUST BE located in the National Capital Region - DMV) Clearance Required: a TS or CBP BI or DHS Suitability clearance adjudicated within the past 4 years ...
Data Scientist (Remote)
Arlington, VA · On-site +1
Washington DC Metro Area - Remote (candidates MUST BE located in the National Capital Region - DMV) Clearance Required: a TS or CBP BI or DHS Suitability clearance adjudicated within the past 4 years ...
Associate Benefit Analyst
Dallas, TX · Remote
This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within ... Implement and maintain benefit requirements within the RxCLAIM adjudication system according to the ...
Associate Benefit Analyst
Dallas, TX · Remote
This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within ... Implement and maintain benefit requirements within the RxCLAIM adjudication system according to the ...
... Remote PRIMARY PURPOSE OF THE ROLE: To supervise the operation of multiple teams of examiners and ... Provides technical/jurisdictional direction to examiner reports on claims adjudication. * Compiles ...
... Remote PRIMARY PURPOSE OF THE ROLE: To supervise the operation of multiple teams of examiners and ... Provides technical/jurisdictional direction to examiner reports on claims adjudication. * Compiles ...
Remote Contract: Long Term Job Type : W2 Rate : $50/hr. on W2 (Without Benefits) * Automation ... adjudication domain (Dental/Vision plans specifically payer & provider aspects) Roles and ...
Remote Contract: Long Term Job Type : W2 Rate : $50/hr. on W2 (Without Benefits) * Automation ... adjudication domain (Dental/Vision plans specifically payer & provider aspects) Roles and ...
Claims Processor (remote) Iowa ONLY
Phoenix, AZ · On-site +1
$16 - $17/hr
Fully Remote position for Iowa residents ONLY!* Job Summary Join our team as a Claims Processing ... Adjudication: Approve, deny, or adjust claims based on payer guidelines and policy terms.
Claims Processor (remote) Iowa ONLY
Phoenix, AZ · On-site +1
$16 - $17/hr
Fully Remote position for Iowa residents ONLY!* Job Summary Join our team as a Claims Processing ... Adjudication: Approve, deny, or adjust claims based on payer guidelines and policy terms.
Claims Processor - Remote / Telecommute
$17.34 - $21.34/hr
Examine and resolve non-adjudicated claims by identifying processing requirements based on contracts, medical policies, and procedures. * Process product- or system-specific claims to ensure timely ...
Claims Processor - Remote / Telecommute
$17.34 - $21.34/hr
Examine and resolve non-adjudicated claims by identifying processing requirements based on contracts, medical policies, and procedures. * Process product- or system-specific claims to ensure timely ...
Partners with multiple business units and teams to ensure the accuracy of claims adjudication ... Remote work options * Generous Paid-Time Off * Annual Reviews and Development Plans * Retirement ...
Partners with multiple business units and teams to ensure the accuracy of claims adjudication ... Remote work options * Generous Paid-Time Off * Annual Reviews and Development Plans * Retirement ...
Enterprise Architect, ServiceNow, Nuvolo, Remote, Contingent
Washington, DC · Remote
$78.25 - $100.75/hr
This remote position requires a strategic thinker with a deep understanding of enterprise ... adjudication processing as applicable. Thank you.
Enterprise Architect, ServiceNow, Nuvolo, Remote, Contingent
Washington, DC · Remote
$78.25 - $100.75/hr
This remote position requires a strategic thinker with a deep understanding of enterprise ... adjudication processing as applicable. Thank you.
Enterprise Architect, ServiceNow, Nuvolo, Remote, Contingent
OR · Remote
$69 - $89/hr
This remote position requires a strategic thinker with a deep understanding of enterprise ... adjudication processing as applicable. Thank you.
Enterprise Architect, ServiceNow, Nuvolo, Remote, Contingent
OR · Remote
$69 - $89/hr
This remote position requires a strategic thinker with a deep understanding of enterprise ... adjudication processing as applicable. Thank you.
Our pharmacy adjudication solutions help speed claims to payers, validate claims accuracy, confirm ... This is a remote role to candidates within the United States. Up to 50% of travel is required. You ...
Our pharmacy adjudication solutions help speed claims to payers, validate claims accuracy, confirm ... This is a remote role to candidates within the United States. Up to 50% of travel is required. You ...
TS or CBP BI or DHS Suitability (clearance adjudicated within the past 4 years) Position Overview ... Remote Work: in an industry of declining remote work opportunities. * People-Focused Culture: we ...
TS or CBP BI or DHS Suitability (clearance adjudicated within the past 4 years) Position Overview ... Remote Work: in an industry of declining remote work opportunities. * People-Focused Culture: we ...
TS or CBP BI or DHS Suitability (clearance adjudicated within the past 4 years) Position Overview ... Remote Work: in an industry of declining remote work opportunities. * People-Focused Culture: we ...
TS or CBP BI or DHS Suitability (clearance adjudicated within the past 4 years) Position Overview ... Remote Work: in an industry of declining remote work opportunities. * People-Focused Culture: we ...
Our pharmacy adjudication solutions help speed claims to payers, validate claims accuracy, confirm ... This is a remote role to candidates within the United States. Up to 50% of travel is required. You ...
Our pharmacy adjudication solutions help speed claims to payers, validate claims accuracy, confirm ... This is a remote role to candidates within the United States. Up to 50% of travel is required. You ...
Business Analyst, Optum CES
Chicago, IL · On-site +1
Remote Employment Type: 1 month contract with possibility of extension We are seeking a seasoned ... adjudication workflows and ensure alignment with payer strategies. Key Responsibilities:
Business Analyst, Optum CES
Chicago, IL · On-site +1
Remote Employment Type: 1 month contract with possibility of extension We are seeking a seasoned ... adjudication workflows and ensure alignment with payer strategies. Key Responsibilities:
Enterprise Architect, ServiceNow, Nuvolo, Remote, Contingent
Washington, DC · Remote
$70.75 - $91/hr
This remote position requires a strategic thinker with a deep understanding of enterprise ... adjudication processing as applicable. Thank you.
Quick apply
Enterprise Architect, ServiceNow, Nuvolo, Remote, Contingent
Washington, DC · Remote
$70.75 - $91/hr
This remote position requires a strategic thinker with a deep understanding of enterprise ... adjudication processing as applicable. Thank you.
Remote Adjudication information
What is the difference between Remote Adjudication vs Remote Claims Processor?
| Aspect | Remote Adjudication | Remote Claims Processor |
|---|---|---|
| Credentials | Typically requires healthcare or insurance industry certifications | Requires insurance or claims processing knowledge, often with certification |
| Work Environment | Primarily analyzing and making decisions on claims remotely | Processing and reviewing insurance claims remotely |
| Industry Usage | Common in healthcare, insurance, and government sectors | Common in insurance companies and third-party administrators |
| Search/Comparison Intent | Understanding roles involving claim decision-making remotely | Understanding roles focused on processing insurance claims remotely |
Remote Adjudication involves analyzing and making decisions on claims, often requiring specialized certifications. Remote Claims Processors handle the review and processing of claims, focusing on data entry and verification. While both roles work remotely within the insurance or healthcare industry, adjudicators focus on decision-making, whereas claims processors handle the administrative processing of claims.
More about Remote Adjudication jobs
What cities are hiring for Remote Adjudication jobs? Cities with the most Remote Adjudication job openings:
What are the most commonly searched types of Adjudication jobs? The most popular types of Adjudication jobs are:
What states have the most Remote Adjudication jobs? States with the most job openings for Remote Adjudication jobs include:
What job categories do people searching Remote Adjudication jobs look for? The top searched job categories for Remote Adjudication jobs are:
Job description
FULL TIME REMOTE
PURPOSE:
Under direct supervision, reviews and adjudicates paper/electronic claims. Determines proper handling and adjudication of claims following organizational policies and procedures.
ESSENTIAL FUNCTIONS:
60% Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures. Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems.
25% Completes research of procedures. Applies training materials, correspondence and medical policies to ensure claims are processed accurately. Partners with Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership. Required participation in ongoing developmental training to performing daily functions.
10% Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc.
5% Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education Level: High School Diploma or GED
Experience: more than three years experience processing claim documents. Experience with processing Inter-Plan Teleprocessing System (ITS) Claims.
Preferred Qualifications
5+ years Claims processing, billing, or medical terminology experience
Knowledge, Skills and Abilities (KSAs)
Demonstrated analytical skills, Proficient
Demonstrated reading comprehension and ability to follow directions provided, Proficient
Basic written/oral communication skills , Proficient
Demonstrated ability to navigate computer applications , Proficient
Previously adjudicated 200-300 medical claims daily with accuracy of 98% or above for prior roles.
About Ageatia Global Solutions
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Ageatia Global Solutions, located in Schaumburg, IL, US, is a reputable IT consultant company that offers a range of premium technical and IT staffing services across numerous industries. Its official website, ageatia.com, is a testament to its dedication to top-tier delivery. Since its inception in 2002, Ageatia has consistently provided optimal services specific to each client's needs. Ageatia's core competency lies in identifying and delivering expert engineers and IT professionals on contract and permanent placements. The company is known for maintaining a business model that ultimately focuses on solving client's workforce challenges. Ageatia's mission is to provide companies with the most skilled set of candidates, while also offering advancing opportunities to potential employees.
Industry
It services
Company size
51 - 200 Employees
Headquarters location
Schaumburg, IL, US
Year founded
2002