Benefit Adjuster I

Role Summary

• Evaluates and processes claims that require routine judgement and investigation such as Diagnostic Testing, Wellness, Physician Expense, URM, GAP, Hospital Indemnity, Medlink, Dental, Triage/Incomplete or Pregnancy claims in accordance with Company policy terms, insurance laws, regulatory requirements and adjusting guidelines.
• Provides appropriate verbal and/or written communication to internal and external Customers in a positive and knowledgeable manner to ensure a high standard of Customer service. Meets standards established in department performance metrics for appropriate handling of Customer phone calls.
• Acts as a direct contact and communicates with Customers and medical providers in a positive, knowledgeable and professional manner, providing them with direction and assistance in all facets of insurance coverage and needs.

Education & Certification

High school diploma or general education degree (GED)

Technical Skills & Requirements

Prompt and reliable

Good medical terminology preferred

Possesses General PC Windows-based software knowledge with the ability to learn new applications and work in a paperless environment

Good understanding of anatomy and physiology

Good contract knowledge

Familiarity with CPT and ICD10 coding

Possesses good analytical skills and judgment

Ability to be flexible in work schedule, including a willingness to work overtime as needed

Good oral and written communication skills

Ability to handle fast-paced environment

Professional attitude

Dedicated to providing world-class Customer service

Ability to work well within a team environment

#AFC