CLAIMS ADJUSTER

Laborers Funds Administrative Office of Northern California Inc • Pleasanton, CA

just now • Onsite

About The Position

The Laborers Funds Administrative Office of Northern California, Inc. is a not-for-profit corporation providing administrative services under contractual agreements for Northern California Laborers Trust Funds. We employ over 100 employees and provide services for over 30,000 Laborers and beneficiaries in the various employee benefit plans we have administered since 1963. We are seeking a medical Claims Adjuster to join our team and deliver outstanding administrative support and customer service to union Laborers and their families.

Requirements

• Two years of prior experience in medical claims processing and customer service
• Ability to work independently and within a high-paced, team-oriented environment
• Proficient in MS Suite (Outlook, Excel, Word) and computer systems and applications
• Ability to multi-task, prioritize and meet deadlines
• Self-motivated and remain calm under pressure
• Analytical and detail-oriented with attention to accuracy
• Flexible and adaptable to changes
• Ability to independently research and remain current on medical coding and policy changes
• Discretion with ability to maintain confidentiality
• Strong interpersonal skills in working with employees, members and other departments
• Basic understanding of call center ACD and IVR systems
• Microsoft Office Suite Testing is required
• Work under Collective Bargaining Agreement
• Union job with union dues

Nice To Haves

• Bi-lingual in Spanish

Responsibilities

• Administering union-negotiated fringe benefits (health and welfare) in accordance with plan documents, with a primary focus on processing medical claims in a fast-paced, high-volume environment.
• Processing medical claims accurately and efficiently.
• Providing excellent customer service by phone and in person to members and their families.
• Communicating policies, regulations, and benefit information clearly.
• Responding to correspondence and inquiries from members, dependents, and providers.
• Collaborating with providers and vendors to resolve claim issues.
• Preparing reports.
• Assisting with special tasks and projects related to claims.
• Responding to legal inquiries, including subpoenas.
• Verifying and updating eligibility with network vendors.
• Assisting and resolving issues on behalf of members.
• Performing additional duties as assigned by supervisors or management.
• Monitoring and adapting to frequent changes and evolving requirements in regulations, organizational guidelines, and medical insurance policies or laws that may impact claims and operations.
• Independently researching updates in medical coding and medical policies.

Benefits

• Medical, dental and vision coverage paid by the employer
• An employee Pension and Annuity plan contributed into by the employer
• Optional participation in a 401K plan
• Sick, vacation time, 8 major holidays, and 2 annual floating holidays under a Collective Bargaining Agreement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed