Hospital Claims Adjuster


The Hospital Claims Adjuster is responsible for the adjusting of hospital risk claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the Hospitals/IPAs. Researches, reviews and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a resource of information to all staff. 

Duties and Responsibilities

  • Accurately review all incoming adjustment requests to verify necessary information is available.
  • Adjust claims in accordance with departmental policies and procedures and other rules applicable to claims.
  • Coordinate resolution of claims issues with other Departments.
  • Assist Providers and other Departments in claims research.
  • Review and adjudicate web portal inquiries.
  • Assist in training claims personnel when issues are identified.
  • Promote a spirit of cooperation and understanding among all personnel.
  • Attend organizational meetings as required
  • Adhere to organizational policies and procedures.
  • Performs other tasks as assigned by Claims Leadership.
  • Adhere to MedPOINT Management’s core value: Accountability, Community, Celebration, Integrity, Innovation & Collaboration
  • Meets production and accuracy standards established by claims management.

Minimum Job Requirements and Experience

High school graduate. One-year experience as a Claims Examiner on an automated claims adjudication system. One-year experience adjudicating hospital risk claims. Strong organizational and mathematical skills. Ability to get work done efficiently and within timeliness guidelines.

Knowledge, Skills and Abilities

  • Knowledge of DOFR interpretation and the adjudication of hospital risk claims.
  • Experience in a managed care environment preferred.
  • ICD-9 and ICD-10 and CPT-4 coding knowledge preferred.
  • Must be detail oriented and have the ability to work independently

Salary Range

  • $20 - $23 per hour

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