Healthcare Claims Adjuster

Healthcare Claims Adjuster I

We are looking for a detail-oriented and proactive Claims Adjuster to join our team. In this role, you'll investigate, evaluate, and resolve insurance claims while ensuring accuracy, compliance, and a positive experience for all stakeholders. If you enjoy problem-solving, analyzing information, and working in a fast-paced environment, this could be a great fit.

Investigate & Evaluate Claims

• Review and assess claims to determine validity and coverage
• Analyze documentation, calculations, and supporting data
• Ensure claims are handled within authority limits and in accordance with company policies and procedures
• Identify and flag exceptions or unusual situations

Maintain Accurate Records

• Update and maintain claims systems and audit records
• Enter, verify, and secure claim-related data with a high level of accuracy

Resolve Claims

• Process claim settlements through payment or denial
• Handle both standard and moderately complex claims

Reporting & Analysis

• Prepare reports by collecting, analyzing, and summarizing claims data and trends
• Support audit and compliance activities

Continuous Improvement

• Attend training sessions to stay up to date on industry regulations, tools, and best practices
• Contribute ideas to improve claims processes and efficiency

Education

• High School Diploma or GED required

Experience

• 3+ years of claims adjusting experience
• Strong understanding of claims systems, policies, and procedures

Preferred Experience

• Medical claims processing and adjustment
• Familiarity with: Medical terminology, Provider refunds, Subrogation, Workers' Compensation, Claims disbursements

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.