Health Claims Adjuster
Title:Health Claims Adjuster
Job Status:N/A
Group Management Services (GMS) located in Richfield, Ohio is seeking to hire a full-time Claims Adjuster for our TPA Services. 

Job Summary:
The medical Claims Adjuster is responsible for analyzing and correctly adjudicating claims for GMS TPA operations.

Duties include:
  • Process claims adjudication
  • Identify claims to be processed in order of identified importance and work within time limitations.
  • Investigate and process all adjustments
  • Investigate and research problem claims
  • Resolve issues and identify customer needs (call on issues if missing information or additional info needed)
  • Verify correct plan loading (making sure claim is processed according to the clients plan)
  • Follow up with pended claims
  • Pull claims for auditing
  • Maintain daily paid claims workload
  • Adjudicate claims and prescriptions for outside vendors
  • Investigate all code review output for a claim and correctly processes according to set procedures
  • Pull pended claims over 30 days old and processes accordingly
  • Investigate and resolve outstanding issues on behalf of the member by communicating with applicable departments and responding to the member.
  • Initiate claim adjustments, additional ID card replacements, duplicate EOB’s, canceled check requests, etc.

     • Minimum high school diploma or equivalent required along with 3-5 years experience in
    health benefits account management or college degree.
     • Exceptional customer service skills
    • Professional
Compensation & Benefits
  • Compensation based on experience
  • Benefits – Medical, Dental, Vision, 401(k), Short Term Disability, Long Term Disability, Tuition Assistance, PTO
  • Other Great Perks: Cell phone reimbursement and gym membership reimbursement.
  • Great work/life balance – Flex time after 90 day, Work from home capabilities
For more information please visit our website at
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