Benefit Adjuster III - Leave Services

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Open to local OKC candidates or fully remote

Evaluates, processes, manages and/or audits claims that require complex judgement and investigation such as , Cancer claims, Leave Absence Management Claims, Short Term Disability claims requiring claim management, Permanent and Total Disability claims or claims requiring Pre-Existing investigation, or life claims and claims on other life-related products and associated riders, and Stop Loss claims in accordance with Company policy terms, insurance laws, regulatory requirements, department standards 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 internal and external 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. 

Requirements:

• Minimum 3 years claims processing experience

• FMLA/PFML experience required

• Prompt and reliable

• Advanced knowledge of medical terminology

• Proficient with PC Windows-based software, including Microsoft Office

• Easily adapts to new software/technology applications and is able to excel in a paperless environment

• Advanced contract knowledge

• Advanced familiarity with CPT and ICD-10 coding

• Possesses a high degree of decision-making ability

• Strong research and analytical skills

• Flexible work schedule, including willingness to work overtime as needed

• Strong communication skills, both verbal and written

• Ability to handle fast-paced environment

• Professional attitude

• Dedicated to providing world-class customer service

• Ability to work in a team environment

*Compensation range: $24.17/hour to $35.87/hour, plus may be eligible for an annual discretionary company bonus. Actual compensation within that range will be dependent upon the individual's skills, experience/qualifications and geographic zone. For more information on our organization and company benefits please visit our career site at http://americanfidelity.com/careers/.

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