Job Description

Operations

The Claims Payment Adjuster is responsible for reviewing, adjudicating, and accurately processing claims in accordance with plan provisions, provider contracts, regulatory requirements, and internal policies. This role ensures timely and accurate claims payment while providing excellent service to providers, members, and internal stakeholders.

Key Responsibilities

• Review and adjudicate claims in accordance with policy benefits, payment methodologies, and contractual agreements
• Identify and resolve claims discrepancies related to eligibility, coverage, coding, billing errors, and authorization requirements
• Document claim decisions clearly and accurately within the claims processing system
• Respond to provider and member inquiries regarding claim status, payment rationale, and benefit interpretation
• Meet productivity, quality, and turnaround time standards established by the organization
• Identify trends or recurring issues and escalate appropriately for process improvement

Required Qualifications

• High school diploma or equivalent
• Minimum 13 years of medical claims processing or claims payment experience
• Working knowledge of medical terminology, benefit structures, and reimbursement methodologies
• Proficiency in CPT, HCPCS, ICD-10, and basic medical billing concepts
• Strong attention to detail with the ability to apply analytical and critical-thinking skills
• Effective written and verbal communication skills
• Ability to work independently and manage multiple priorities in a high-volume environment

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

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