Benefit Adjuster III - Leave Services
About The Position
Evaluates, processes, manages and/or audits claims that require complex judgement and investigation such as , Cancer claims, Leave Absence Management Claims, Short Term Disability claims requiring claim management, Permanent and Total Disability claims or claims requiring Pre-Existing investigation, or life claims and claims on other life-related products and associated riders, and Stop Loss claims in accordance with Company policy terms, insurance laws, regulatory requirements, department standards and adjusting guidelines. Provides appropriate verbal and/or written communication to internal and external Customers in a positive and knowledgeable manner to ensure a high standard of Customer service. Meets standards established in department performance metrics for appropriate handling of Customer phone calls. Acts as a direct contact and communicates with internal and external Customers and medical providers in a positive, knowledgeable and professional manner, providing them with direction and assistance in all facets of insurance coverage and needs.
Requirements
- Minimum 3 years claims processing experience
- FMLA/PFML experience required
- Prompt and reliable
- Advanced knowledge of medical terminology
- Proficient with PC Windows-based software, including Microsoft Office
- Easily adapts to new software/technology applications and is able to excel in a paperless environment
- Advanced contract knowledge
- Advanced familiarity with CPT and ICD-10 coding
- Possesses a high degree of decision-making ability
- Strong research and analytical skills
- Flexible work schedule, including willingness to work overtime as needed
- Strong communication skills, both verbal and written
- Ability to handle fast-paced environment
- Professional attitude
- Dedicated to providing world-class customer service
- Ability to work in a team environment
Responsibilities
- Evaluates, processes, manages and/or audits claims that require complex judgement and investigation such as , Cancer claims, Leave Absence Management Claims, Short Term Disability claims requiring claim management, Permanent and Total Disability claims or claims requiring Pre-Existing investigation, or life claims and claims on other life-related products and associated riders, and Stop Loss claims in accordance with Company policy terms, insurance laws, regulatory requirements, department standards and adjusting guidelines.
- Provides appropriate verbal and/or written communication to internal and external Customers in a positive and knowledgeable manner to ensure a high standard of Customer service.
- Meets standards established in department performance metrics for appropriate handling of Customer phone calls.
- Acts as a direct contact and communicates with internal and external Customers and medical providers in a positive, knowledgeable and professional manner, providing them with direction and assistance in all facets of insurance coverage and needs.
Benefits
- annual discretionary company bonus
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
