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Remote Claims Adjudicator

Addison Group • Contract • Remote (Illinois, United States) • 1w ago

Job Title: Remote Claims Adjudicator

Location: Remote (open to all U.S. locations except California and New York; preference for Illinois)

Industry: Healthcare – Claims Processing

Pay: $25 – $27 / hour (depending on experience)

Benefits: Dental , Vision , Medical , 401k

About Our Client:

Our client is a leading value-based care and managed service organization that partners with independent providers to drive transformative change in healthcare. This role is fully remote and part of a growing national team.

Job Description:

The Claims Adjudicator will play a key role in supporting critical aspects of claims examination, focusing on authorization matching, duplicate claim identification, and adjudication of BCBS HMO claims. This production-based position is designed to help reduce a significant claims backlog while ensuring accuracy and compliance with guidelines.

Key Responsibilities:

Approve or deny claims for payment by verifying proper authorizations and resolving system hold codes
Review claims against established criteria (dates, codes, etc.) to authorize payment
Identify duplicate claims and support denial processes during adjudication
Coordinate benefits and payments between multiple insurance companies (COB savings)
Investigate and resolve claims issues from Customer Service inquiries
Analyze recurring provider or member issues, recommend solutions to management
Provide feedback to update standard operating procedures
Maintain HIPAA compliance regarding patient privacy
Contribute to team goals and productivity standards

Qualifications:

2+ years of medical claims processing experience (BCBS HMO preferred)
Experience working with UB04 and CMS-1500 claim forms
Strong understanding of claims adjudication steps and denial management
Production-focused and comfortable working independently
Proficient in Microsoft Office (Outlook, Teams, Word, Excel)
Prior experience with EZCap claims software preferred
Availability to work an 8-hour shift between 7:00 AM – 6:00 PM CST

Additional Details:

Type of Assignment: Contract through end of year
Productivity Target: 50 – 60 claims / day
Environment: Remote, production-focused
Compliance: Background check and drug screen required

Perks:

Fully remote opportunity with national impact
Work for a leading value-based healthcare organization
Opportunity to gain exposure to complex claims processing and denial management
Supportive and collaborative leadership team

Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.

IND 004-008

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