Adjustment Specialist

Jun 20, 2012
Jun 20, 2012
Employment Status
Full Time

Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota’s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We’re an organization that’s going places. Be part of a team that cares about you, be part of UCare.

The Adjustment Specialist  will research and process complex medical claims adjustment requests from UCare providers. Specific duties and responsibilities include:

  • Review and resolve complex medical claims adjustment requests for all Ucare products per department policy and procedures..
  • Maintain department production and quality standards.
  • Respond to claim adjustment or referral inquiries from Customer Service, Provider Network Management, Provider Assistance Center, and Health Care Management.
  • Resolve adjustmemts involving other health coverage through Workers' Compensation, No-Fault Auto, Refund, or other Third Party Liability.
  • Review department policy and procedures for accuracy and suggest improvements where necessary.
  • Complete assigned special projects that require research, analysis and documentation

A high school diploma or equivalent is required. Course work in medical terminology is also necessary. A two year degree in a health care related field is preferred.

Two years of experience in medical claims processing, CPT and ICD-9 coding is required. Medical terminology and experience with Medicare and/or Medicaid benefits is necessary. Six months or more of Amisys claims processing experience is highly desired. Medicare and/or Medicaid claims processing is preferred.


Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You’ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis—just minutes from major freeways and retail centers. At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

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