Claims Adjuster

Company Description
Lumen Solutions Group Inc. is a technology consulting Services company based in Florida. We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, Enterprise Transformation. 

Role: Claims Adjuster
Location: Baltimore, MD(Remote)
Type: Contract

Position Overview
We are seeking an experienced Claims Adjuster to join our healthcare claims team. This role will begin with claims processing responsibilities during the training period before transitioning into a Claims Adjuster position. The ideal candidate will possess a strong background in healthcare claims processing and claims adjustments, with experience working on payer-side operations. This position is ideal for professionals who have hands-on experience reviewing, researching, adjusting, and resolving claims-related issues while ensuring accuracy and compliance with established guidelines.
 
Key Responsibilities

• Review, process, and adjust healthcare claims accurately and efficiently.
• Investigate claim discrepancies and perform claim adjustments as needed.
• Analyze claim information to determine appropriate resolution and payment outcomes.
• Research and resolve claims-related issues, including adjustments, overpayments, underpayments, and recovery activities.
• Maintain accurate documentation of claim actions and resolutions.
• Collaborate with internal departments to ensure timely claim processing and issue resolution.
• Adhere to payer policies, procedures, and regulatory requirements.
• Utilize claims processing systems and platforms to manage daily workloads.

 
Required Qualifications

• Minimum 4+ years of healthcare claims experience, including:
  • 3+ years of claims processing experience (MUST HAVE)
  • 1+ year of claims adjusting experience (MUST HAVE)
• Strong knowledge of healthcare claims processing and adjudication.
• Hands-on experience performing claims adjustments and claim issue resolution.
• Experience working for a healthcare payer/insurance organization preferred.
• Excellent analytical, problem-solving, and attention-to-detail skills.
• Ability to work independently in a remote environment.

 
Preferred Qualifications

• Experience with Facets G6 (highly preferred).
• Experience with Paero platform.
• Knowledge of Workers' Compensation claims.
• Understanding of Subrogation processes.
• Familiarity with claims recovery, adjustments, and reimbursement activities.
• Experience working in a high-volume healthcare claims environment.

 
Lumen Solutions Group Inc is an equal opportunity employer. All qualified applicants will be considered for employment without regard to any legally protected status.