Benefit Adjuster I

Job description

‎ * 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