at Robert Half in Aurora, Illinois, United States
Job Description
Description
As a Claims Adjudicator II, you will play a crucial role in our claims processing team. You will be responsible for receiving, examining, verifying, and inputting claim data, determining eligibility status, and adjudicating claims within established timeframes. This position involves processing medical, disability, vision, and dental claims, as well as handling provider and member inquiries. After approximately 6 weeks of on-site training, this position will transition to a fully remote role.
Key Responsibilities:
+ Screen claims for completeness and necessary information.
+ Verify participant and dependent eligibility.
+ Interpret plan benefits from the Summary Plan Description (SPD)/Plan Documents.
+ Code information and select codes to determine payment liability.
+ Evaluate diagnoses, procedures, and services to ensure accuracy and appropriateness.
+ Determine the need for additional information or documentation from participants, employers, providers, and other insurance carriers.
+ Manage the end-to-end process of Medicare Secondary Payer (MSP) files.
+ Process Personal Injury Protection (PIP) claims.
+ Request overpayment refunds, maintain files, and perform follow-up actions.
+ Handle verbal and written inquiries from internal and external customers.
+ Process Short Term Disability claims.
+ Adjudicate claims according to productivity and quality goals.
+ Achieve individual goals to meet or exceed departmental metrics.
RequirementsQualifications:
+ Minimum 3-5 years of experience in medical claim adjudication.
+ Proficient in interpreting benefit plans, including understanding limitations, exclusions, and schedule of benefits.
+ Knowledgeable in subrogation processes.
+ Experience with eligibility verification, medical coding, coordination of benefits, and subrogation.
+ Familiarity with medical terminology, ICD10, and Current Procedural Technology (CPT) codes.
Compensation:
+ Hourly rate: $20.31 – $24.92 (based on experience, qualifications, certifications, education, and location).
Work Schedule:
+ Monday to Friday, 7.5 hours per day (37.5 hours per week).
+ Full-time remote position after initial training period.
Technology Doesn’t Change the World, People Do.®Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity – whenever you choose – even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.
All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
© 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .
