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Independent Health
Independent Health
1,001 – 5,000 Employees
H1B Visa SponsorHealthcareHealthcare InsuranceInsurance
Independent Health is a Western New York health insurance organization and one of the region’s earliest Health Maintenance Organizations (HMOs). It provides coverage and related services to approximately 355,000 people through more than 100 plans, products, and services. Its work includes commercial health insurance, pharmacy benefits, Medicare Advantage, and self-funded health plans. The company describes its culture as focused on helping members and employees bring out their best.
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Claims Adjudicator – Medical and Dental Claims

Process medical and dental claims for Nova Healthcare Administrators, reviewing payments, coding, benefits, and customer questions. This hybrid role requires onsite attendance in Williamsville as needed.

USUnited StatesNYNew York
$19 / hour
HybridFull-timeJuniorNo degree requiredEnglish RequiredGeneral

Description

  • Assess and adjust medical and dental claims using established criteria and client plan documents.
  • Address client, member, and provider questions about claim status, benefit design, and payments alongside Customer Service Representatives.
  • Process facility, professional, member-submitted, pharmacy, and dental claim edits for in-network and out-of-network benefits.
  • Review vouchers and payment explanations to find and resolve claim issues.
  • Meet departmental targets for output, accuracy, policy and procedure knowledge, and timely processing.
  • Investigate policy, payment, and coding matters.
  • Keep knowledge of contracts, summary plan descriptions, and benefits up to date.
  • Apply critical thinking when processing claims.
  • Use systems and applications to find details specific to each claim.
  • Find, interpret, and apply resources to individual claim scenarios.
  • Spot and communicate opportunities to improve processes.
  • Organize and prioritize claim-processing work.
  • Work with other Independent Health departments to resolve claim payment problems.
  • Attend the Williamsville office when required.

Requirements

  • A high school diploma is required.
  • A medical office assistant certificate and/or college degree is preferred.
  • At least six months of medical claims processing or medical billing experience, customer service experience preferably in healthcare or social services, or an equivalent combination of experience.
  • Knowledge of medical billing procedures.
  • Knowledge of CPT and ICD-9 coding.
  • Knowledge of medical terminology.
  • Data entry proficiency and familiarity with Microsoft Office products.
  • Strong organizational skills, attention to detail, and follow-through.
  • Strong written, verbal, and interpersonal communication skills.
  • Ability to communicate effectively with internal and external customers.
  • Ability to work collaboratively.
  • Flexibility to work additional hours as needed.
  • Examples of demonstrating Nova’s Core 4: Act with Passion, Work Together, Be Accountable, and Build Trust.
  • Ability to meet departmental deadlines and turnaround times and comply with state and federal regulations.
  • Immigration or work visa sponsorship is not provided.

Benefits

  • First-class perks and benefits.
  • Eligibility for scorecard incentives.
  • A full range of benefits.
  • Generous paid time off.
  • Hybrid work arrangement.

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