Medical Claims Adjuster I

Utah Retirement Systems•Salt Lake City, UT

9h•Hybrid

About The Position

This position plays a critical role in PEHP’s efforts to serve and create value for our members by processing a variety of medical claims proficiently and timely. The position includes a variety of professional duties related to processing claims. Successful performance for this position requires an attention to detail, the ability to learn complex claims processes while managing multiple diverse tasks, and a high level of commitment and dependability.

Requirements

High School diploma and one (1) year of work experience.
Specific experience in claims processing, and various administrative functions is preferred, or an equivalent combination of education and experience.
Requires working knowledge of: Intricacies related to medical, dental, pharmacy, and Medicare Supplement claims.
Requires working knowledge of: Procedures and processes; intricacies related to medical, mental health and chiropractic claims
Requires working knowledge of: CPT, ICD-10-CM and HCPC’s coding and medical terminology
Requires working knowledge of: Various office management systems related to alpha and numeric record keeping
Requires working knowledge of: Personal computer operations and various program applications
Some knowledge of 10 key operation
Mathematical skills
Must possess excellent communication skills: Interpersonal communication skills; telephone etiquette
Must possess excellent communication skills: Communicate effectively verbally and in writing
Must have the ability to: Analyze a variety of routine claims management issues and problems and make routine corrections
Must have the ability to: Maintain a strong attention to detail.
Must have the ability to: Follow written and verbal instructions.
Must have the ability to: Prioritize work, multi-task, follow through with assignments, and perform within deadlines.
Must have the ability to: Deal effectively with stress caused by workload and time deadlines.
Must have the ability to: Work well in a team environment as well as independently.
Must have the ability to: Follow through with assignments.

Responsibilities

Receives and enters medical and/or Medicare claims for payment under medical and/or Medicare Supplement plans.
Reviews claims for accuracy and completeness, verifies coverage and eligibility of patient.
Adjudicates routine and complex claims according to established policy guidelines.
Processes coordination of benefits on Medical and Dental claims.
Maintains regular and reliable attendance.
Maintains strict confidentiality.
Performs other related duties as required.