Job Description

Job Description

Job Description

Claims Adjuster

Are you eager to start your career in medical claims? Bring your enthusiasm and attention to detail to our team as a Claims Adjuster I!

Job Summary:

As a Claims Adjuster I, you will be an essential part of our claims processing team, working to determine insurance carrier liability and accurately interpret contract benefits. You will be responsible for organizing and utilizing important information regarding benefits, contract coverage, and policy decisions. You'll coordinate daily workflow to ensure all service guarantees are met, and you'll maintain positive relationships with policyholders, service providers, agents, attorneys, and other carriers, as well as work effectively with your peers and management.

Essential Duties & Responsibilities:

• Adjudication & Decision Making: Conduct thorough examinations, perform necessary research, and make informed decisions to properly adjudicate claims and respond to written inquiries.
• Contract Interpretation: Interpret contract benefits accurately, adhering to specific claims processing guidelines.
• Strategic Insight: Understand the broad strategic concepts of our business and connect these to the day-to-day functions of claims processing.
• Professional Interaction: Maintain minimal yet effective external contact with providers, agents, and policyholders.

Qualifications:

• Communication Skills: Excellent oral and written communication skills.
• Technical Proficiency: Proficient in PC applications with accurate typing skills (30 wpm).
• Relevant Experience: Previous experience in health, Medicare, or prescription claims adjudication is a plus.
• Organizational Skills: Strong organizational and decision-making skills.
• Team Collaboration: Team-oriented with a strong work ethic and reliability.
• Claims Expertise: Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims.
• Medical Knowledge: Familiarity with medical terminology, procedure, and diagnosis codes preferred.
• Software Familiarity: Experience with Qiclink software is advantageous.
• Analytical Ability: Ability to calculate figures and co-insurance amounts.
• EOB Interpretation: Proficient in reading and interpreting Explanation of Benefits (EOBs).
• Adaptability: Capable of multitasking, prioritizing, problem-solving, and adapting to a fast-paced, dynamic environment.
• Independent Work: Ability to work independently while meeting quality and production standards.
• Policy Understanding: Clear understanding of policy benefits and procedures within the Claims unit.
• Integrity: Honesty and respect for company policies and procedures are essential.

Education & Experience

• Educational Background: High School diploma or GED equivalent.
• Work Experience: Minimum of one year of related experience required.
• Industry Experience: Experience in medical/insurance is preferred, with Medicare Supplement experience being highly desirable.

If you are ready to start your career in medical claims and have a passion for helping others, we want to hear from you!

Apply today to join our Claims Adjuster I team and begin your journey with us.

#talrooprofessional

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