Hospital Invoices - Claims Adjuster

Job Summary

The Hospital Invoices Specialist supports health claims operations by reviewing, validating, and processing hospital invoices related to insured members’ hospitalization cases. The role ensures correct application of contracted price lists, benefits, approvals, and reimbursement rules, contributing to accurate provider payments and efficient claims handling.

Key responsibilities

• Review and validate hospital invoices related to hospitalization cases.
• Ensure alignment with contracted price lists, coverage rules, and approved services.
• Verify coding, quantities, dates, and supporting medical documentation.
• Identify discrepancies or overcharges and follow up with providers.
• Apply reimbursement rules, policy limits, and cost‑sharing accurately.
• Ensure invoiced services match pre‑authorizations and approvals.
• Liaise with h...