Claims Adjuster

Pay Rate: $25/hr on W2Must-Have:• Must have a Laptop/computer with internet to work from home.• Comfortable providing a Photo ID CopyTerms of Employment: Duration: W2 Contract-to-Hire, 6 monthsLocation: 100% Remote (Strictly restricted to residents of the DC, Maryland, Virginia - DMV area)Training Hours: Strict 8:00 AM – 4:30 PM (4–6 weeks)Post-Training Hours: Flexible schedule with an 8-hour workday starting anytime between 7:00 AM and 9:00 AMOverview:Actively seeking a detail-oriented Claims Adjuster to join the Medicare/Medicaid team at a prominent, market-leading healthcare insurance organization. Operating in a 100% remote capacity within the DMV region, this role is essential to resolving provider financial discrepancies and maintaining payment integrity. This position is structured as a six-month contract-to-hire opportunity, serving as an excellent pipeline for skilled professionals to establish a long-term, permanent career within a fast-paced, collaborative corporate environment.Key Responsibilities:Analyze, review, and adjust claims data associated with provider disputes, retractions, disbursements, and chart reviews.Research and identify claim overpayments or underpayments in coordination with internal payment integrity teams and external vendor communications.Process foundational medical claims efficiently to resolve operational backlogs and manage pending claims queues as business needs dictate.Navigate and leverage complex claims processing software, adapting quickly to modern system features and platform updates.Successfully ramp up production output following an extensive training period to meet established benchmarks, such as managing a standard daily target of 50 provider disputes or related operational queues.Required Qualifications:Minimum of 3 total years of healthcare claims processing experience.Minimum of 1 year of hands-on claims adjustment experience.Solid core comprehension of the overall claims lifecycle and processing rules required to execute adjustments accurately.Highly adaptive behavioral profile with a proven capacity to learn complex systems rapidly in a fast-paced environment.Must maintain physical residency within the DMV (Washington D.C., Maryland, Virginia) area.Preferred Qualifications:Direct experience utilizing the Facets processing system (specifically the Facets G6 platform).Familiarity or operational exposure to the Perio payment integrity platform.Demonstrable background processing or adjusting claims related to Subrogation or Workers’ Compensation.Professional experience handling government lines of business, including Medicaid, Medicare, DSNP, Egg Whip, or NAPD.Background working on the health insurance payer side of the industry.