Claims Adjudicator

Independent Health

. Adjudicate and adjust medical and/or dental claims against established criteria and client SPDs .

Posted 10/20/2026full-timeBuffalo • New York • United StatesJunior💰 $19 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical claims processing, including knowledge of CPT and ICD-9 coding, medical billing procedures, and the ability to analyze and resolve claim-related issues. Strong communication and organizational skills are essential for effective collaboration and adherence to deadlines.

Highest-signal resume keywords

Medical Claims Processing ExperienceCPT And ICD-9 Coding KnowledgeMedical Billing Procedures KnowledgeData Entry ProficiencyCustomer Service Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Claims ProcessingCPT CodingICD-9 CodingMedical Billing ProceduresData EntryMicrosoft Office ProficiencyPolicy AnalysisClaim AdjustmentBenefit KnowledgeCritical Thinking

Soft Skills

Attention To DetailWritten CommunicationVerbal CommunicationInterpersonal CommunicationCollaboration

Certifications & Qualifications

Medical Office Assistant Certificate

Industry Keywords

HealthcareClaims ProcessingBenefit DesignCustomer ServiceState And Federal Regulations

About the role

Key responsibilities & impact

Adjudicate and adjust medical and/or dental claims against established criteria and client SPDs
Respond to client, member, and provider inquiries on claim status, benefit designs, and claim payments in conjunction with Customer Service Representatives
Adjudicate facility, professional, member-submitted, pharmacy, and dental claim edits for in- and out-of-network benefits
Review vouchers and explanations of payments to identify and resolve claim-related issues
Meet department performance measures for production, accuracy, policy and procedure knowledge, and timeliness
Analyze, identify, and research policy, payment, and coding issues
Maintain current contract, summary plan description, and benefit knowledge
Use critical thinking to process claims
Navigate systems and applications to locate claim-specific information
Locate, interpret, and apply resources to claim scenarios
Identify and communicate process opportunities or improvements
Prioritize and manage claim-processing workload
Collaborate with other Independent Health departments to resolve claims payment problems
Attend onsite at the Williamsville location as required

Requirements

What you’ll need

High school diploma required
Medical office assistant certificate and/or college degree preferred
Six (6) months of medical claims processing/medical billing experience, customer service experience preferably in a healthcare related or social services setting; OR combination of experience
Knowledge of medical billing procedures
CPT and ICD-9 coding knowledge
Medical terminology knowledge
Proficiency with data entry skills and Microsoft Office products
Solid organizational skills with attention to detail and follow through
Good 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
Proven examples of displaying Nova’s Core 4: Act with Passion, Work Together, Be Accountable, Build Trust
Ability to adhere to departmental deadlines and turn-around times and comply with State and Federal regulations
Immigration or work visa sponsorship will not be provided

Benefits

Comp & perks

First-class perks and benefits
Scorecard incentive eligibility
Full range of benefits
Generous paid time off
Hybrid work arrangement