Claims Adjudicator – Entry Level/Remote Hiring ASAP

Job Responsibilities : Claims Adjudicator – Entry Level/Remote Hiring ASAP

Salary : Competitive Salary

Company : WellSense Health Plan

United States
•  ID:2014752
•  Full-Time/Regular

This role offers the flexibility to telecommute* from select states within the U.S. as you take on some tough challenges.

If you’re ready for the next step forward and an opportunity to build on your skills, there’s never been a better time to join the WellSense team.

Job Summary:

Responsible for the accurate and timely processing of claims while meeting established quality and productivity standards. Also, responsible for simple adjustments to previously processed claims.

Key Functions/Responsibilities

Provide general claims support by reviewing, researching, investigating, processing and adjusting claims
Identify trends and report to Supervisor as necessary
Review and analyze data from system-generated reports for in-process claims in order to identify and resolve errors prior to final adjudication

Consistently meet established productivity, schedule adherence and quality standards
Other duties as assigned
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.


Education Required:

High School Diploma / GED (or higher)

Education Preferred:

Associate degree or some college coursework (preferred)


Experience Preferred/Desirable:

2+ years of administrative experience (i.e. office, administrative, clerical, customer service, etc.)
1+ years of experience processing medical, dental or prescription claims
Competencies, Skills and Attributes

Experience with Facets system
Familiarity with UB04’s and CMS 1500’s
Experience with Microsoft Excel (ability to create, edit, filter and sort through spreadsheets)
Experience with Microsoft Word (ability to create and edit documents)

Experience with Microsoft Outlook (ability to send/receive emails and calendar invites)
Understand and maintain HIPAA confidentiality and privacy standards when completing assigned work
Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
Navigate across various computer systems to locate critical information

Attention to detail to ensure accuracy, which will support timely processing of the member’s claim
Strong communication skills (internally and externally)
Ability to work with minimal supervision while meeting deadlines

Working Conditions and Physical Effort:

Regular and reliable attendance is an essential function of the position
Ability to work OT during peak periods

Telecommuting Requirements

Required to have a dedicated work area established that is separated from other living areas and provides information privacy
Ability to keep all company sensitive documents secure (if applicable)
Must live in a location that can receive an approved high-speed internet connection or leverage an existing high-speed internet service

All Telecommuters will be required to adhere to WellSense’s Telecommuter Policy.

WellSense requires all new hires and employees to report their COVID-19 vaccination status.

*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status

Apply Now

Leave a Reply

Your email address will not be published. Required fields are marked *