CLAIMS ADJUSTER (147)

THE LOOMIS COMPANY•Wyomissing, PA

4d•Onsite

About The Position

The Claims Adjuster adjudicates claims and provides service to clients, claimants, and providers. The role is expected to meet or exceed defined claim-processing production, processing accuracy, and customer service accuracy standards. The position is based at the company headquarters in Wyomissing, Pennsylvania, and is a full-time day-shift role. The adjuster examines, processes, calculates, and adjudicates claims in accordance with plan documentation and applicable state laws, policies, and company procedures. The role also handles audits, daily processing priorities, customer service and HR logs, and questions about claims or policies by telephone or correspondence. Claims information must be kept confidential. Continuing education may be required, and business conditions may require overtime. Other functions may be assigned as business conditions change. The job involves regular keyboard work, verbal communication, and close-vision computer use. The employee may need to lift or move up to 15 pounds. The work environment typically has a moderate noise level. The position may require access to private health information (PHI) or electronic private health information (EPHI), with access limited to what is necessary for job responsibilities. Regular attendance in accordance with company standards is required; reasonable accommodation may be made for individuals with disabilities.

Requirements

High school diploma or GED.
1–3 years of adjusting experience.
Strong attention to detail when reviewing documents and evolving policies.
Analytical thinking skills to interpret a wide variety of instructions.
Ability to learn quickly and creatively solve new problems.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Strong work ethic and time-management skills to handle daily claim production goals efficiently.
Ability to interpret and apply manuals, SPDs, medical terminology, and insurance claims provisions.
Excellent verbal and written communication skills.
Knowledge of Microsoft Office products and a claims system.
Ability to perform regular keyboard work, verbal communication, and close-vision computer use; may need to lift or move up to 15 pounds.
Maintain regular attendance acceptable to company standards.

Nice To Haves

Direct experience adjudicating medical claims or in-depth medical billing knowledge is highly preferred.

Responsibilities

Examine, process, calculate, and adjudicate claims in compliance with plan documentation.
Process open audits daily.
Follow daily priorities for high-dollar claims and other issues listed in reports distributed each morning and afternoon.
Maintain customer service logs within a five-day turnaround time.
Maintain HR logs within a two-day turnaround time.
Comply with state laws, policies, company procedures, and plan documentation.
Enter codes and verify data for computer processing.
Meet or exceed daily claim production goals and processing accuracy standards.
Respond by telephone or correspondence to claimants, providers, and clients with questions or problems regarding claims or policies.
Meet or exceed customer service quality standards.
Protect operations by keeping claims information confidential.
Attend continuing education on claims processing as needed.
Perform other functions as assigned when business conditions change.