Adjudicator Jobs

About The Position

Requirements

• Current professional certification or credential in a relevant healthcare field, such as Medical Assisting, Medical Billing, Medical Coding, or Healthcare Claims; examples include CMA, RMA, CCMA, CPC, CCS, or another recognized healthcare-related credential.
• Strong understanding of medical terminology, healthcare processes, and common treatments for acute and chronic conditions.
• Strong analytical and critical-thinking skills, including the ability to interpret detailed medical information and apply established guidelines.
• Excellent written and verbal communication skills.
• Exceptional attention to detail and ability to make fair, consistent, and objective decisions.
• Ability to work efficiently in a fast-paced environment while managing multiple systems and priorities.
• Proficiency with Microsoft Office and comfort learning new software and CRM systems.
• Ability to type at least 45 WPM.

Nice To Haves

• Experience reviewing medical records, healthcare claims, medical bills, coding, or supporting medical documentation.
• Previous experience in healthcare, medical review, case management, claims adjudication, utilization review, or a health-sharing organization.
• Experience working within a CRM or case-management system.
• Spanish fluency; may qualify for additional compensation.

Responsibilities

• Review medical records and supporting documentation submitted with medical sharing requests for completeness, accuracy, and consistency with Zion HealthShare Member Guidelines.
• Apply knowledge of medical terminology, conditions, diagnostics, procedures, evidence-based treatments, and typical treatment timelines when reviewing requests.
• Research medical information and treatment standards when additional context is needed.
• Collaborate with internal teams to obtain clarification or additional documentation.
• Make consistent, well-supported determinations about eligibility for sharing or the need for additional information.
• Document determinations and the rationale supporting each decision.
• Stay current on Member Guideline updates and relevant healthcare and treatment practices.
• Identify opportunities to improve or clarify Member Guidelines and provide recommendations when appropriate.
• Protect member information by maintaining confidentiality and following HIPAA and organizational requirements.
• Approach determinations with accuracy, consistency, and compassion for the member experience.

Benefits

• 13 paid holidays, including the employee’s birthday and a Personal Preference Day, plus paid time off.
• Medical, dental, and vision coverage.
• HSA with company contributions.
• Supplemental benefits, including life and short-term disability coverage.
• Zion HealthShare membership.
• Free Direct Primary Care (DPC) membership.
• 401(k) with a 4% company match.
• Biweekly pay.
• Free onsite snacks and regular company lunches.
• Frequent team-building activities and opportunities to connect with coworkers.