Claims Administrator

Application Deadline:

Application Deadline: 03/21/2024



10 Years


New Jersey






Key Responsibilities:
Claims Processing:

Review and process medical insurance claims submitted by healthcare providers.
Verify patient eligibility, coverage, and benefits according to insurance policies.
Evaluate claim documents, medical records, and invoices to determine validity and accuracy.
Code claims accurately using standardized medical coding systems (e.g., ICD-10, CPT) and ensure compliance with regulatory requirements.

Adjudication and Resolution:

Assess claims for completeness, accuracy, and compliance with contractual agreements.
Determine claim reimbursements based on established fee schedules, policies, and guidelines.
Investigate discrepancies, denials, and rejections and resolve issues through appropriate channels.
Communicate with healthcare providers, insurers, and patients to clarify claim details and resolve disputes.

Documentation and Recordkeeping:

Maintain detailed records of claims, payments, and correspondence for auditing and reporting purposes.
Document claim status updates, decisions, and resolutions accurately in the claims management system.
Ensure confidentiality and security of sensitive medical and financial information in accordance with privacy regulations (e.g., HIPAA).

Customer Service:

Respond to inquiries from healthcare providers, insurers, and patients regarding claim status, coverage, and payment issues.
Provide assistance and guidance on claims submission processes, documentation requirements, and reimbursement procedures.
Handle customer concerns and complaints professionally and effectively, striving to achieve satisfactory resolutions.

Quality Assurance and Compliance:

Conduct regular reviews and audits to ensure compliance with internal policies, industry regulations, and best practices.
Identify areas for process improvement and efficiency enhancement in claims administration workflows.
Stay updated on changes in healthcare laws, regulations, and insurance policies affecting claims processing and reimbursement.

Responsibilities & Context:


  • Bachelor’s degree in Healthcare Administration, Business Administration, or related field (preferred).
  • Certification in Medical Billing and Coding (e.g., CPC, CCS) is highly desirable.
  • Proven experience (10 years) working in medical claims processing or healthcare revenue cycle management.
  • Proficiency in medical terminology, coding systems (e.g., ICD-10, CPT), and healthcare billing software.
  • Strong analytical skills with the ability to interpret complex data and documentation.
  • Excellent communication skills, both verbal and written, for effective interaction with stakeholders.
  • Detail-oriented mindset with a focus on accuracy and precision in claims adjudication.


The equal employment opportunity policy of the OMNISTAR Solutions LLC., provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. OMNISTAR Solutions LLC., hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
OMNISTAR Solutions LLC. does not tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.


Employment Status:


Job Location:

New Jersey

Apply Here!