• Claims Adjuster II

    Job Locations US-VA-Glen Allen
    Job ID
  • Overview

    The Claims Adjuster II is responsible for the accurate and timely processing of pended claims of moderate complexity received by the Claims Department. The Claims Adjuster II is also responsible for communicating with internal staff, vendors, providers, and billing representatives on the outcome of claims processed as well as the status of outstanding claims. 


    • Process pended claims accurately and within the time frames established by
    • Management and Contractual Agreements using the claims document imaging system and the claims processing system.
    • Manually enter in un-scannable paper claims in the claims processing system
    • Complete ChangeGear tickets assigned within established time frames
    • Master a thorough understanding of such claim types as Nursing Facility, Home Health, and EDCD Waiver services
    • Master a thorough understanding of such items as HCPC and Procedure codes, modifiers and their effect on reimbursement, appropriate billing guidelines for anesthesia claims, dialysis, durable medical equipment (DME), and home health services.
    • Work claims reports as directed by management
    • Work as a unit/team in resolving claims issues or special projects
    • Report any inconsistencies that are identified in regards to internal department policies and procedures or potential billing issues to Management
    • Work with Management to ensure that all existing workloads have been addressed and are within acceptable time frames
    • The ability to provide phone coverage for Claims Customer Service
    • The ability to work overtime as needed
    • Perform other duties as assigned



    •  High school diploma or equivalent.


    • Experience to IDX and QNXT claims processing systems
    • Strong organizational, written, and verbal skills
    • Exposure to health care environment and knowledge of CMS 1500 and UB04 Claim forms
    • CPT-4 and ICD9/ICD10 knowledge
    • Ability to work independently and in a team environment
    • Ability to meet deadlines and work under pressure in a Production based-Goal oriented environment


    • Minimum two (2) years claims processing/healthcare billing experience


    • Physical health sufficient to meet the ergonomic standards and demands of the position.


    About Us

    Virginia Premier is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 


    We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  


    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE


    Our mission is to inspire healthy living within the communities we serve!


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