Claims Adjuster

Pay Rate: $25/hr on W2

Must-Have:

• Must have a Laptop/computer with internet to work from home.

• Comfortable providing a Photo ID Copy

Terms of Employment:

• Duration: W2 Contract-to-Hire, 6 months
• Location: 100% Remote (Strictly restricted to residents of the DC, Maryland, Virginia - DMV area)
• Training Hours: Strict 8:00 AM – 4:30 PM (4–6 weeks)
• Post-Training Hours: Flexible schedule with an 8-hour workday starting anytime between 7:00 AM and 9:00 AM

Overview:

Actively seeking a detail-oriented Claims Adjuster to join the Medicare/Medicaid team at a prominent, market-leading healthcare insurance organization. Operating in a 100% remote capacity within the DMV region, this role is essential to resolving provider financial discrepancies and maintaining payment integrity. This position is structured as a six-month contract-to-hire opportunity, serving as an excellent pipeline for skilled professionals to establish a long-term, permanent career within a fast-paced, collaborative corporate environment.

Key Responsibilities:

• Analyze, review, and adjust claims data associated with provider disputes, retractions, disbursements, and chart reviews.
• Research and identify claim overpayments or underpayments in coordination with internal payment integrity teams and external vendor communications.
• Process foundational medical claims efficiently to resolve operational backlogs and manage pending claims queues as business needs dictate.
• Navigate and leverage complex claims processing software, adapting quickly to modern system features and platform updates.
• Successfully ramp up production output following an extensive training period to meet established benchmarks, such as managing a standard daily target of 50 provider disputes or related operational queues.

Required Qualifications:

• Minimum of 3 total years of healthcare claims processing experience.
• Minimum of 1 year of hands-on claims adjustment experience.
• Solid core comprehension of the overall claims lifecycle and processing rules required to execute adjustments accurately.
• Highly adaptive behavioral profile with a proven capacity to learn complex systems rapidly in a fast-paced environment.
• Must maintain physical residency within the DMV (Washington D.C., Maryland, Virginia) area.

Preferred Qualifications:

• Direct experience utilizing the Facets processing system (specifically the Facets G6 platform).
• Familiarity or operational exposure to the Perio payment integrity platform.
• Demonstrable background processing or adjusting claims related to Subrogation or Workers’ Compensation.
• Professional experience handling government lines of business, including Medicaid, Medicare, DSNP, Egg Whip, or NAPD.
• Background working on the health insurance payer side of the industry.