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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in processing complex adjustments and managing overpayments and underpayments while facilitating audits. Strong communication and teamwork skills are essential for mentoring team members and collaborating effectively.
Highest-signal resume keywords
Claims ProcessingAdjustment Requests ManagementHigh Dollar Audits FacilitationTeam MentoringVerbal And Written Communication
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Complex Adjustments HandlingOverpayment ProcessingUnderpayment ProcessingCORE Claim Adjudication SystemClinical Audits
Soft Skills
Excellent CommunicationIndependent WorkCollaborative TeamworkSelf-Starter
Tools & Technologies
Computer Systems
Industry Keywords
Claims DepartmentAdjustment RequestsVendor Management
About the role
Key responsibilities & impact- Handle complex adjustments
- Process all overpayments and underpayments received from multiple departments
- Process adjustment requests through emails, reports, or the CORE claim adjudication system
- Facilitate clinical high dollar audits with vendors
- Mentor team members of the Claims Department
Requirements
What you’ll need- High School Diploma or Equivalent
- 3-5 Years Related Experience
- Excellent verbal and written communication skills
- Able to work independently and collaboratively in teams
- Self starter
- Proficient in using computers and computer systems
- Licensure/Certification/Registration: N/A
Benefits
Comp & perks- Medical, Vision, Dental
- Retirement with Employer Match
- Benefits eligibility for employees working 20+ hours/week
