Medical Claims Adjuster III
About The Position
Guarantee Trust Life Insurance Company (GTL) is currently seeking a Medical Claims Adjuster III to join our team! Since 1936, GTL has offered cutting-edge insurance solutions and personalized service for our policyholders and distributors, while supporting personal growth and civic involvement from our employees. We’re seeking candidates who are looking for meaningful work, who want to invest in their growth, and contribute to a company built on timeless virtues and best business practices. This position is required to work on-site in our Elkhorn, NE office most days. Everyone receives 3 flexible remote days per month. And, we offer half-day Fridays – every Friday!
Requirements
- 3-5 years of medical health claim adjusting experience
- Experience reading and referencing policy language for benefit administration.
- Experience investigating and adjusting contestable claims.
- Strong attention to detail and good judgement.
- Strong verbal and written communication skills.
Nice To Haves
- Prior experience with Short-Term Home Health Care, Long Term Care, and/or Cancer/Heart Attack/Stroke claims.
Responsibilities
- Adjudicate claims based on variable contract provisions and benefits according to state guidelines.
- Understand policy contract language, insurance applications, medical terminology, and medical aspects.
- Compose clear, professional correspondence and letters to customers, physicians, and healthcare providers related to coverage determinations, claim payments, denial notifications, appeals, and documentation requests.
- Handle difficult phone calls from insureds, family members, and healthcare providers.
- Take inbound calls and make outbound calls.
- Work within a production environment.
- Maintain proper Quantity and Quality metrics while working within this production environment.
Benefits
- Medical Health Savings Account (including employer contribution)
- Dental
- Vision
- Basic Life Insurance (full premium paid by employer)
- Voluntary Employee, Spouse and Child Life Insurance
- Short-Term and Long-Term Disability
- Paid Holidays
- Paid time off including vacation, personal days, sick time and Flex Fridays
- 401(k), 401(k) Match and Profit-Sharing Retirement Plan
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
