Claims Adjuster Jobs

About The Position

Requirements

• A high school diploma or GED equivalent
• Minimum of 1 year proven health insurance claims adjudication experience.
• Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims required.
• Ability to read and interpret EOB’s claim history, and excellent research skills.
• Familiarity with Microsoft Office products; familiarity with Qiclink software a plus.
• Ability to calculate deductible and co-insurance amounts.
• Ability to adapt and respond to different types of people and tasks.
• Excellent communication and documentation skills.
• Ability to multi-task, prioritize, and manage time effectively and efficiently.
• Reliable transportation and the ability to be punctual and dependable.

Nice To Haves

• Insurance background preferred; previous Medical/prescription claims preferred.
• Familiarity with medical terminology, procedures and diagnosis codes preferred.

Responsibilities

• Examine/perform/research & make decisions necessary to properly adjudicate claims and written inquiries.
• Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions.
• Interpret contract benefits in accordance with specific claim processing guidelines.
• Coordinate daily workflow to coincide with check cycle days to meet all service guarantees.
• Based on established guidelines and/or historical knowledge an adjuster will need to recognize red flags for potential fraud or waste and escalate accordingly.
• Adjusters who handle the potential fraud or waste claims will investigate, track via clear and complete system notes and accurately report on each file/case in a timely manner.
• Understand broad strategic concept of our business and link these to the day-to-day business functions of claims processing.
• Maintain external contact with providers/agents/policyholders.

Benefits

• Medical/Dental/Vision Insurance
• 401(k) Retirement Plan
• Paid Holidays
• PTO
• Community Service PTO
• FSA/HSA
• Life Insurance
• Short-Term and Long-Term Disability