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Claims Adjudicator

Location
Allentown, PA, US
Workplace
On-site
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About this role

The Claims Adjudicator position is responsible for assuring claims received from billing providers are evaluated for data integrity and validating the Patient Responsibility before processing to the secure Member Portal; building and maintaining outstanding relationships with providers.

Job Duties/Essential Functions: 

  • Processes electronic and paper claims on a daily basis.
  • Verifies and reviews claims received are accurate before adjudication.
  • Reviews and resolves claim discrepancies in a timely manner.
  • Contacts billing providers to correct AblePay Member ID and insurance information as needed.
  • Establishes a working relationship with billing providers, Members, and internal staff.
  • Assists Members on any related dispute/issue as authorized.
  • Assists Members with general billing questions.
  • Contacts medical providers to negotiate the greatest discount/savings on out of network claims.
  • Performs other related duties as assigned by management.


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