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Top 50 Adjudicator Skills

Below we've compiled a list of the most important skills for an Adjudicator. We ranked the top skills based on the percentage of Adjudicator resumes they appeared on. For example, 15.5% of Adjudicator resumes contained Long-Term Disability as a skill. Let's find out what skills an Adjudicator actually needs in order to be successful in the workplace.

These are the most important skills for an Adjudicator:

1. Long-Term Disability

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high Demand

2. Social Security

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high Demand
Here's how Social Security is used in Adjudicator jobs:
  • Provide professional disability adjudication for Social Security Administration disability applicants.
  • Maintain a high level of technical expertise in Social Security rules and regulations relating to disability benefits and supplemental income benefits.
  • Draft case determinations and rationales summarizing pertinent evidence related to claimant's functional status and benefit eligibility under social security regulations.
  • Determined level of functioning of claimant and composted Residual Functional Capacity Evaluations for Social Security Administration (SSA).
  • Performed administrative work in researching, analyzing, and evaluating claims for disability benefits under the Social Security Act.
  • Conducted review of the evidence and materials for analysis against the Social Security Disability Regulations.
  • Prepare determinations on eligibility for Social Security disability based on the medical and vocational findings.
  • Adjudicated medical claims in accordance with Social Security provisions using established policies and procedures.
  • Case Management and Subject Matter Expert to determine and Validate Social Security Disability Benefits
  • Obtained medical, vocational and other evidence for Social Security disability claims.
  • Developed and evaluated claims for social security disability insurance benefits.
  • Partnered with Social Security on any questionable claim activity.
  • Reviewed claims for Social Security disability insurance applicants.
  • Managed Social Security claims in determination process.
  • Evaluated claims for Social Security Disability.
  • Adjudicated Social Security Disability claims.
  • Developed, evaluated and formalized the medical portion of claims for Social Security Disability and SSI.
  • Applied Social Security's policies and contract provisions to adjudicate assigned claims.
  • Follow and practice policies set by Social Security.
  • Collect, review, examine & analyze evidence to determine eligibility for Social Security disability benefits and prepare detailed decisional documents.

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1 Social Security Jobs

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3. Insurance Companies

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Here's how Insurance Companies is used in Adjudicator jobs:
  • Job Duties included validating insurance and working insurance companies to facilitate payment of pharmaceutical insurance claims.
  • Contacted insurance companies to collect missing information for patients.
  • Submitted incoming prescriptions to insurance companies for payment.
  • Billed claims to insurance, worked denials for prescriptions, and helps unpaid prescriptions pay with various commercial and government insurance companies
  • Assisted nursing staff, physician offices, and insurance companies ensuring timely payment of online submitted claims.
  • Excelled at analyzing causes for rejection, interpreting policies and negotiating with insurance companies to obtain approvals.
  • Answered questions from responsible parties and insurance companies regarding claims.
  • Processed claims for hospital administrations Billed insurance companies for medication shipments
  • Processed insurance claims Collected revenue for claims from insurance companies

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4. Medical Records

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Here's how Medical Records is used in Adjudicator jobs:
  • Investigate allegations by abstracting relevant data from medical records and using established criteria to determine severity of disability.
  • Maintain confidentiality of all candidate information to include medical records and personnel security adjudications.
  • Order and review medical records to determine if disability meets Social Security guidelines.
  • Requested and reviewed medical records from different medical sources and made eligibility determinations.
  • Managed between 60 and 100 cases at any given time.-Analyzed and summarized medical records to make a succinct case file.
  • Evaluated documents such as claim applications, and medical records to determine if eligible for pursuing a claim.
  • Authorize payments for travel on mileage for kept consultative exam appointments and for medical records and information received.
  • Request medical records from doctors, hospitals, clinics, special education and other sources using AS400.
  • Reviewed medical records, medical history and prior claim files to make determination decisions on claims.
  • Request and review medical records and assess claims according to SSA disability guidelines.
  • Read and interpret medical records, consult with doctors and interview applicants.
  • Review medical records and compile reports to present findings of investigations.
  • Review Medical records and recommend decisions for DRG payment approval.
  • Organized and filed medical records for time sensitive retrieval.
  • Read through medical records and write precise medical reports.
  • Submit medical records to NGS for ADR request.
  • Review the medical records to obtain relevant information.
  • Request and review medical records.
  • Deny claims to incorrect coding, Conduct medical records research and corresponds with healthcare professionals to resolve the issue.

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5. Adjudicative Guidelines

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Here's how Adjudicative Guidelines is used in Adjudicator jobs:
  • Utilize Adjudicative Guidelines for determining eligibility for access to classified information.

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1 Adjudicative Guidelines Jobs

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6. Security Personnel

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7. Customer Service

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Here's how Customer Service is used in Adjudicator jobs:
  • Communicated with commercial airline headquarters on daily basis to maintain performance goals and customer service standards.
  • Provide exemplary customer service to internal and external customers.
  • Delivered exceptionable customer service to our customers.
  • Provided customer service for any long-term care pharmacy that had questions on how to resolve pharmacy claims.
  • Provide customer service in a call center for the employer hot line by answering questions on unemployment.
  • Provide direct customer service to workers, employers, providers and legal representatives.
  • Advanced customer service and communication skills needed to complete this job.
  • Manage a caseload of claims and provide excellent customer service.
  • Provide and maintain quality customer service.
  • Managed prior authorization process with 48 hours follow-up, worked backlog of denied claims for resubmission Promoted to Triage/Customer Service Super visor

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8. Unemployment Claims

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Here's how Unemployment Claims is used in Adjudicator jobs:
  • Develop factual cases to determine eligibility for unemployment claims.
  • Update, resolve escalated issues/concerns related to unemployment claims.
  • Identified and reviewed issues associated with unemployment claims.
  • Conducted interviews and investigated unemployment claims.
  • Ensured that unemployment claims were processed in adherence to State law, policies, and precedent decisions.
  • Gather info from claimants and employers concerning unemployment claims.
  • Prepare written reports and fact finding on unemployment claims.

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9. Patient Care

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10. Medicaid

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Here's how Medicaid is used in Adjudicator jobs:
  • Worked rejected Medicaid, Medicare Part D, Third Party and Hospice pharmacy claims, obtaining overrides wherever possible.
  • Identify and resolve denied claims prior to medication delivery, working with nursing facilities, insurance companies and Medicaid.
  • Report (Medicaid rejects).
  • Reprocessed Medicare claims for payment through redetermination and appeal for the Center of Medicare and Medicaid through Blue Cross Blue Shield.
  • Verified long-term care patients' demographic and billing information for Medicare, Medicaid, Hospice, Private and Third-Party payersources.
  • Work Medicaid Pending reports from i-Astral and the operating system to ensure timely application of Medicaid coverage.
  • Process unpaid claims by contacting insurance companies Experience working with Medicaid and Medicare Insurance Work with QS-1 and Docutrack

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11. Medical Evidence

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Here's how Medical Evidence is used in Adjudicator jobs:
  • Prepare summary of all medical and non-medical evidence citing specific clinical and laboratory findings, claimant statements and third party information.
  • Review and adjudicate medical evidence received from treating sources in order to determine claimant's disability for Social Security Benefits.
  • Marshaled medical evidence, employment history and documentation of education and special skills.
  • Determine disability according to medical evidence, disability guidelines and vocational considerations.
  • Gathered and analyzed medical evidence from treating sources regarding alleged impairments.
  • Review medical evidence needed for processing social security disability claims.
  • Interpreted given medical evidence for human anatomy and physiology.
  • Evaluated psychological and medical evidence.
  • ANALYZE ISSUES: Consults with the program's medical consultants on the significance and relevance of medical evidence.
  • Ensured completion of medical evidence for claim processes.
  • Review applications and medical evidence for disability Apply federal legislation; approve/deny disability applications

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12. Additional Information

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Here's how Additional Information is used in Adjudicator jobs:
  • Request additional information as necessary from government field offices or investigative units.
  • Reevaluated evidence and procured additional information in connection with claims under appeal.
  • Reviewed medical documentation for payment or requested additional information for review.
  • Obtain additional information from a variety of sources in order to make fair adjudicative assessments.

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13. Security Clearance

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Here's how Security Clearance is used in Adjudicator jobs:
  • Make interim and/or final security clearance and public trust certification determination in accordance with established investigative and adjudicate standards.
  • Summarize data; render security clearance eligibility recommendations; and update and maintain Department of Defense automated systems.
  • Assist in adjudicating personal background investigations for suitability for employment and/or issuance of a security clearance.
  • Ensured individuals being evaluated possessed judgment, reliability and honesty standards required for security clearance eligibility.
  • Prepare concise summary to determine eligibility for a security clearance.
  • Screened personnel security clearance requests for completeness.
  • Maintain Defense Clearance Investigation Index case files for Air Force military, civilian and contractor personnel requiring security clearances.
  • Worked with Clearance Writers to determine if applicant could obtain Security Clearance.

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14. Facility Staff

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Here's how Facility Staff is used in Adjudicator jobs:
  • Work with nursing facility staff, physician offices, and insurance companies to ensure timely payment of online submission of claims.

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15. State Laws

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16. Unemployment Benefits

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Here's how Unemployment Benefits is used in Adjudicator jobs:
  • Interviewed, investigated and documented facts from involved parties to determine eligibility for unemployment benefits.
  • Considered information presented to DES agency and render decisions on unemployment benefits.
  • Make initial determination on claimants' eligibility for unemployment benefits.
  • Determine eligibility for Unemployment benefits in accordance with M.G.L.
  • Review, process the claims and inform the claimant/representative regarding the approval and/or denial of their claim for Unemployment benefits.
  • Compose decision letter regarding approval or denial of unemployment benefits to claimants, employers and interested parties.
  • Issue written legal decisions of eligibility for unemployment benefits based on state law.
  • Interview Claimants for unemployment benefits, create fact finding and request any additional information needed to make an accurate determination.
  • investigate and make legally binding determinations in regards to unemployment benefits.

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1 Unemployment Benefits Jobs

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17. Background Checks

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18. Hipaa

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Here's how Hipaa is used in Adjudicator jobs:
  • Maintain complete confidentiality of personal information and comply with all HIPAA guidelines.
  • Maintained confidentiality and adhered to all HIPAA guidelines/regulations.
  • Adhered to and participates in Company's mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices.
  • Followed all regulations which include but not limited to the HIPAA guidelines.

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19. Data Entry

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Here's how Data Entry is used in Adjudicator jobs:
  • Edit claims in the system for processing, Use data entry to place claims on record.
  • Complete necessary documents, and data entry of transaction.
  • Review and data entry of medical claims.

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20. Vocational Evidence

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Here's how Vocational Evidence is used in Adjudicator jobs:
  • Collected and evaluated medical, psychological, and vocational evidence needed to determine eligibility for disability benefits.
  • Collected, reviewed and interpreted relevant medical and vocational evidence and evidence of activities of daily living.
  • Interviewed claimants and physicians to obtain medical and vocational evidence.
  • Gathered medical and vocational evidence to build disability cases.

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21. Disability Determination

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Here's how Disability Determination is used in Adjudicator jobs:
  • Prepared written decisions applying federal rules and regulations to the evidence of record to make well-reasoned disability determinations.
  • Examine disability claims and/or cases to make disability determinations.
  • Prepared written documentation to explain the disability determination
  • Pull claimants disability allegations from records and enter into eCat system for SSA doctors to review for disability determination.

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22. Functional Capacity

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Here's how Functional Capacity is used in Adjudicator jobs:
  • Use medically reasonable judgment to prepare residual functional capacity statements for physical and mental impairments.

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23. State Regulations

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Here's how State Regulations is used in Adjudicator jobs:
  • Researched, analyzed, and applied federal and state regulations to compose and deliver Medicare appeal determinations.

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24. Phone Calls

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Here's how Phone Calls is used in Adjudicator jobs:
  • Answer phone calls and direct calls to appropriate parties or take messages.
  • Answered all Incoming and outgoing phone calls.
  • Answer phone calls concerning these matters.

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25. Ncic

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26. TSA

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Here's how TSA is used in Adjudicator jobs:
  • Make eligibility recommendations for Transportation and Security Administration (TSA) applicants and employees based on approved guidelines.
  • Transmitted investigative forms in accordance with TSA guidelines to be forwarded to Office of Personnel Management (OPM).
  • Prepared reports and forms accordance with instructions provided by TSA.
  • Federated IT, supporting USDHS-TSA-TTAC I conducted National Security Threat Assessments of individuals, foreign & domestic.

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27. Medicare

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Here's how Medicare is used in Adjudicator jobs:
  • Follow all Medicare/Medi-Cal guidelines and procedures.
  • Created accurate timely billing for private pay patients, facilities, Medicare, and 3rd party insurance companies.
  • Work with multiple computer applications, using the Standard Medicare System, Internet and Windows applications.
  • Make necessary and appropriate recommendation for medical payment, per Medicare Part A.
  • Complete data entry to the web based Medicare appeals system.
  • Employed Clinical Adjudicator Medicare Appeals 1st & 2nd Clinical Revies Medicare Query Review Transcription of Medicare Regulated documents
  • Job Responsibilities: * Billings of Medicare primary, secondary claims electronically.
  • Managed various insurance claims from Medicare, TriCare and VA, including accounts receivable and payables.
  • Define and resolves issue that impede payment on Medicare account receivables.

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28. Final Decision

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Here's how Final Decision is used in Adjudicator jobs:
  • Analyzed complex information and prepare final decision letters to subjects providing the nexus for rendering the eligibility recommendation.
  • Worked closely with ombudsmen to draft final decisions where recommendations by adjudicator's were appealed.
  • Conduct hearings, review documents, and render final decisions based on a totality of the evidence.
  • Assessed complete claim and make the final decision on the claim.
  • Make final decision on whether benefits should be allowed or denied.

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29. Initial Claims

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30. Appropriate Action

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Here's how Appropriate Action is used in Adjudicator jobs:
  • Reviewed and researched rejected Third-Party claims and took appropriate action to resolve.
  • Review and research Third-Party claims taking appropriate action to resolve them.

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31. Relevant Information

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Here's how Relevant Information is used in Adjudicator jobs:
  • Conferred with individuals or organizations involved in cases to obtain relevant information.

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32. Third-Party Vendors

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33. Questionable Data

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34. OPM

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Here's how OPM is used in Adjudicator jobs:
  • Reviewed completed investigation, analyze and summarize the information, make adjudication recommendations for OPM Adjudicators.
  • Scheduled additional investigation to resolve issues and obtain documented evidence to support OPM's decision.
  • Evaluated applicants for economic development grants.
  • Assessed the required level of investigation based on job specific duties and position description using OPM's Position Designation Tool.
  • Conducted electronic fingerprinting of federal employees and contractors to process Advanced NAC's through OPM and FBI.
  • Reviewed serious issue cases to determine if the issues warrant OPM action.
  • Reviewed claims and planed case development to adjudicate claims.
  • Participated in Employer Ethics Training and Development.
  • DOCUMENT CONTROL & BUDGET MANAGEMENT: - Conducts in-depth analysis of OPM investigation reports and recommends adjudicative action.

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35. DOD

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Here's how DOD is used in Adjudicator jobs:
  • Protect DOD Army Division Community by integrating consolidated risk management into all aspects of our missions.
  • Reviewed cases in accordance with (IAW) DoD 5200.2-R, work products consistently demonstrated knowledge of personnel security policies/ procedures.

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36. Applicable Government Regulations

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Here's how Applicable Government Regulations is used in Adjudicator jobs:
  • Follow applicable government regulations including HIPAA.

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37. Credit Reports

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Here's how Credit Reports is used in Adjudicator jobs:
  • Request financial records with credit reports to prepare Statements of Reason/Letter of Intent, Warning Letters, and Conditional Letters.
  • Work with Equifax to obtain credit reports when needed.

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38. Jpas

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Here's how Jpas is used in Adjudicator jobs:
  • Processed clearance eligibility using the Joint Personnel Action System (JPAS) and the Clearance Adjudication Tracking System (CATS).
  • Work with JPAS to update clearances that can be adjudicated and cases that can't.
  • Input clearance determination into the Joint Personnel Adjudication System (JPAS).
  • Review personnel security packages to ensure information is complete in JPAS.

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39. Valid Claims

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Here's how Valid Claims is used in Adjudicator jobs:
  • Authorize cellular phone replacement request of valid claims and notify the insured of approval or denial status.
  • Interviewed claimants or agents, authorized payment of valid claims, notified claimants of denials.
  • Authorized payment of valid claims and notified claimant of denied claim and appeal rights.
  • Authorized payment of valid claims.

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40. Special Projects

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Here's how Special Projects is used in Adjudicator jobs:
  • Conducted quality assurance, mentoring/training personnel, and related special projects.
  • Participated in special projects and performs other duties as assigned.
  • Perform other reasonably related duties including special projects as assigned by immediate supervisor and other management staff.

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41. Vocational Information

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Here's how Vocational Information is used in Adjudicator jobs:
  • Obtained appropriate medical and vocational information from the claimants.
  • Requested and obtained medical and vocational information.
  • Obtained appropriate medical and vocational information and determines its' relevance in making claims determination.

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42. SCI

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Here's how SCI is used in Adjudicator jobs:
  • Verify alien's immigrations status by running a SAVE (Systemic Alien Verification and Entitlements) through USCIS.
  • Make adjudicative recommendation for access to Special Compartmented Information (SCI) in accordance with DCID 6/4.
  • Conducted adjudications to determine suitability of SCI access for the National Reconnaissance Office - diverse, multi-national, multi-organizational.

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43. Physician Offices

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44. Medical Professionals

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Here's how Medical Professionals is used in Adjudicator jobs:
  • Conducted telephone interviews with claimants, medical professionals, and family members in order to obtain additional information.
  • Identified sources of medical/non-medical information, conducted fact-finding interviews with medical professionals, lay sources, community services.
  • Conducted fact finding interviews with claimants and medical professionals.
  • Consult with medical professionals for insight on complex cases.

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45. Medical Consultants

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46. ICD

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Here's how ICD is used in Adjudicator jobs:
  • Interpret and process claims using knowledge of ICD-9 codes, billing, benefits, and company policies.

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47. LTC

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Here's how LTC is used in Adjudicator jobs:
  • United RX, LTC Pharmacy Enrolled patients located at LTC facilities in database and verified demographic/insurance information.

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48. As400

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Here's how As400 is used in Adjudicator jobs:
  • Worked with multiple Microsoft programs (Word, Outlook, Excel) as well as with an AS400 program.
  • Analyze current and past customer orders through AS400 to identify payment and send out claims for underpayment.

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49. Dcii

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Here's how Dcii is used in Adjudicator jobs:
  • Interpreted coded information for into the Clearance Management System (CMS) and Defense Clearance and Investigative Index (DCII).
  • Work with DCII for incident reports and police reports.

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50. Criminal Investigations

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Adjudicator Jobs

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20 Most Common Skills For An Adjudicator

Long-Term Disability

20.0%

Social Security

12.6%

Insurance Companies

7.9%

Medical Records

7.7%

Adjudicative Guidelines

6.4%

Security Personnel

6.1%

Customer Service

5.6%

Unemployment Claims

4.9%

Patient Care

3.8%

Medicaid

3.1%

Medical Evidence

2.8%

Additional Information

2.8%

Security Clearance

2.7%

Facility Staff

2.3%

State Laws

2.2%

Unemployment Benefits

1.9%

Background Checks

1.9%

Hipaa

1.8%

Data Entry

1.8%

Vocational Evidence

1.5%
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Typical Skill-Sets Required For An Adjudicator

Rank Skill
1 Long-Term Disability 15.5%
2 Social Security 9.8%
3 Insurance Companies 6.1%
4 Medical Records 5.9%
5 Adjudicative Guidelines 5.0%
6 Security Personnel 4.8%
7 Customer Service 4.3%
8 Unemployment Claims 3.8%
9 Patient Care 3.0%
10 Medicaid 2.4%
11 Medical Evidence 2.2%
12 Additional Information 2.1%
13 Security Clearance 2.1%
14 Facility Staff 1.8%
15 State Laws 1.7%
16 Unemployment Benefits 1.5%
17 Background Checks 1.5%
18 Hipaa 1.4%
19 Data Entry 1.4%
20 Vocational Evidence 1.2%
21 Disability Determination 1.1%
22 Functional Capacity 1.1%
23 State Regulations 1.1%
24 Phone Calls 1.0%
25 Ncic 1.0%
26 TSA 0.9%
27 Medicare 0.9%
28 Final Decision 0.8%
29 Initial Claims 0.8%
30 Appropriate Action 0.8%
31 Relevant Information 0.8%
32 Third-Party Vendors 0.8%
33 Questionable Data 0.8%
34 OPM 0.7%
35 DOD 0.7%
36 Applicable Government Regulations 0.7%
37 Credit Reports 0.7%
38 Jpas 0.7%
39 Valid Claims 0.7%
40 Special Projects 0.7%
41 Vocational Information 0.7%
42 SCI 0.6%
43 Physician Offices 0.6%
44 Medical Professionals 0.6%
45 Medical Consultants 0.6%
46 ICD 0.5%
47 LTC 0.5%
48 As400 0.5%
49 Dcii 0.5%
50 Criminal Investigations 0.5%
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55 Adjudicator Jobs

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