Medical Claims Adjudication Specialist – Dearborn, Michigan

Job Description

About the Company

Skill Gigs is a global IT and healthcare consulting firm that connects skilled professionals with leading organizations worldwide. This opportunity is with one of our U.S.-based healthcare partners, focused on processing and adjudicating medical insurance claims.

Job Title

Medical Claims Adjudication Specialist

Location

Dearborn

Job Overview

We are seeking a detail-oriented and analytical Medical Claims Adjudication Specialist to review and process healthcare insurance claims. In this role, you will evaluate claims, determine coverage, and ensure accurate reimbursement.

Key Responsibilities

Review and adjudicate medical insurance claims
Verify patient eligibility and coverage details
Apply policy guidelines to approve or deny claims
Identify discrepancies and resolve claim issues
Maintain accurate records and documentation
Collaborate with insurance providers and healthcare teams
Ensure compliance with regulatory and policy standards
Track claim processing metrics and generate reports
Handle appeals and reprocessing of claims
Improve claims adjudication workflows

Required Qualifications

Bachelor’s degree in Healthcare Administration, Finance, or related field
1–3 years of experience in claims processing, adjudication, or healthcare billing roles
Basic understanding of medical coding and billing (ICD, CPT)
Strong analytical and attention-to-detail skills
Good communication and problem-solving abilities
Ability to work with claims management systems

Preferred Qualifications

Experience in insurance companies or healthcare billing departments
Familiarity with claims adjudication systems
Knowledge of healthcare regulations and compliance
Understanding of reimbursement policies and payer systems
Certification in medical billing or coding (preferred)

Why Join Us?

Work with a leading U.S.-based healthcare organization
Gain hands-on experience in claims adjudication and insurance processes
Supportive and collaborative work environment
Competitive salary and benefits
Opportunities for career growth in healthcare finance and administration

How to Apply

Submit an ATS-friendly resume highlighting your experience in claims adjudication, billing, and relevant healthcare or insurance skills.