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Claims Adjudication Specialist

Vaco
$60.00 - $70.00 / hr
United States, Florida, Orlando
Jan 29, 2025

Vaco is seeking aClaims Adjudication Specialist!

This role is designed to bridge the gap between claims processing and insurance payor operations. Remote. Bachelors and over 5 years of experience required.

The Claims Adjudication Specialist will ensure claims are processed accurately and efficiently, working between claims processing and insurance payor operations. This fully remote role requires minimal travel.

Key Responsibilities:

  • Review claims from insurance companies to ensure they're processed correctly and in compliance with regulations.
  • Analyze claims data to spot issues, trends, or areas for improvement.
  • Select appropriate sample sizes to evaluate claims and ensure accuracy.
  • Work with internal and external teams to align claims with contractual agreements.
  • Provide expertise on insurance payor systems and claims adjudication.
  • Investigate and resolve claims that are improperly adjudicated.
  • Stay current on healthcare regulations and payer requirements.

Qualifications:

  • Bachelor's degree in Healthcare Administration, Business, or related field (or equivalent experience).
  • 5+ years of experience in claims adjudication or healthcare insurance.
  • Strong understanding of healthcare policies and claims processing workflows.
  • Analytical skills to work with large datasets and draw actionable insights.
  • Excellent communication and collaboration skills.
  • Proficiency in claims management systems or healthcare analytics tools.

Desired Competencies:

  • Detail-oriented with a focus on accuracy.
  • Experience with complex payor systems.
  • Strong problem-solving skills.
  • Knowledge of Medicare/Medicaid, HIPAA, and value-based care regulations.

    Vaco values a diverse workplace and strongly encourages women, people of color, LGBTQ+ individuals, people with disabilities, members of ethnic minorities, foreign-born residents, and veterans to apply.

    EEO Notice

    Vaco is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race (including but not limited to traits historically associated with race such as hair texture and hair style), color, sex (includes pregnancy or related conditions), religion or creed, national origin, citizenship, age, disability, status as a veteran, union membership, ethnicity, gender, gender identity, gender expression, sexual orientation, marital status, political affiliation, or any other protected characteristics as required by federal, state or local law.

    Vaco LLC and its parents, affiliates, and subsidiaries are committed to the full inclusion of all qualified individuals. As part of this commitment, Vaco LLC and its parents, affiliates, and subsidiaries will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact HR@vaco.com .

    Vaco also wants all applicants to know their rights that workplace discrimination is illegal.

    By submitting to this position, you agree that you will be giving Vaco the exclusive right to present your as a candidate for the foregoing employment opportunity. You further agree that you have represented information about yourself accurately and have not affirmatively misrepresented your qualifications. You also agree to maintain as confidential, to the fullest extent permitted by law, any information you learn from Vaco about the position and you will limit disclosure of information about the position only to the extent necessary to perform any obligations in furtherance of your application. In exchange, Vaco agrees to exercise reasonable efforts to represent you through all solicitation, job screening and resume dispersal.

    Privacy Notice

    Vaco LLC and its parents, affiliates, and subsidiaries ("we," "our," or "Vaco") respects your privacy and are committed to providing transparent notice of our policies.

    • California residents may access Vaco's HR Notice at Collection for California Applicants and Employees here.
    • Virginia residents may access our state specific policies here.
    • Residents of all other states may access our policies here.
    • Canadian residents may access our policies in English here and in French here.
    • Residents of countries governed by GDPR may access our policies here.
    Pay Transparency Notice

    Determining compensation for this role (and others) at Vaco depends upon a wide array of factors including but not limited to:

    • the individual's skill sets, experience and training;
    • licensure and certification requirements;
    • office location and other geographic considerations;
    • other business and organizational needs.

    With that said, as required by local law, Vaco believes that the following salary range referenced above reasonably estimates the base compensation for an individual hired into this position in geographies that require salary range disclosure. The individual may also be eligible for discretionary bonuses.

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