[Hiring] Healthcare Claims Processor @J29

Role Description

J29 is seeking a Junior Healthcare Claims Analyst/Adjudicator to support healthcare claims operations. This entry-level to early-career position is responsible for reviewing and processing healthcare claims in accordance with established procedures, benefit requirements, system rules, and quality standards.

• Complete routine claims processing activities.
• Verify claim and member information.
• Review claims for completeness and accuracy.
• Apply documented processing rules.
• Escalate exceptions or complex issues to senior team members.
• Detail-oriented, dependable, and comfortable working in a structured production environment.
• Willing to learn specialized benefit and claims processing requirements.

Qualifications

• One to three years of experience in healthcare claims processing, medical billing, provider billing, health insurance operations, healthcare administration, data entry, customer service, or a related field is preferred.
• Previous healthcare claims adjudication experience is helpful but not required for candidates with relevant healthcare operations or medical billing experience.
• Basic understanding of the healthcare claims lifecycle.
• Strong attention to detail and commitment to accurate data entry and documentation.
• Clear written communication skills for documenting claim actions and questions.
• Basic proficiency with Microsoft Excel, Word, Teams, Outlook, and other computer-based systems.

Requirements

• Review professional, institutional, and other healthcare claims for completeness, accuracy, and compliance.
• Verify member eligibility, dates of service, provider information, billed services, authorization information, and other required claim data.
• Apply documented benefit rules, reimbursement guidelines, system edits, and processing instructions to adjudicate claims accurately.
• Process routine claims, adjustments, corrections, pends, denials, and rejections within assigned authority and training.
• Identify missing, conflicting, or incomplete information and follow established procedures to resolve or escalate the issue.
• Research routine claim edits, payment questions, duplicate claims, eligibility issues, authorization requirements, and coding-related discrepancies.
• Participate in quality reviews, feedback sessions, refresher training, and corrective action activities.
• Complete required claims processing, system, privacy, security, and program-specific training.
• Protect confidential member, patient, provider, and claims information.

Benefits

• Employee-centered culture with high retention rates.
• Opportunity for professional development and training.
• Supportive team environment.