3 years claims experience and complete understanding of all systems, policies and procedures
Ability to analyze information gathered from investigation
Excellent communication skills both written and verbal
Requirements:
Investigate and perform adjustment of claims and ensure that claims are handled properly within authority limits
Verify insurance claims by reviewing claims requirements and examining documentation
Update claims audit records by entering, verifying, and securing data
Settle standard/complex claims through payment or denial
Job description
Our client, a Health Insurance company, is looking for a Claims Adjuster I for their Remote location.
Responsibilities:
Investigate and perform adjustment of claims and ensure that claims are handled properly within authority limits, and in line with standard procedures and guidelines.
Verifies insurance claims by reviewing claims requirements; examining documentation and calculations; highlighting and summarizing out-of-line situations; recommending changes in operating processes; completing reports, logs, and audit records.
60% Proactively investigate and perform adjustments of claims.
Ensure claims are handled within authority limits, and in line with standard procedures and guidelines.
20% Updates claims audit records by entering, verifying, and securing data.
10% Settle standard/complex claims through payment or denial.
5% Provides claims audit information and reports by collecting, analyzing, and summarizing data and trends.
5% Improves claims adjustment job knowledge by attending training sessions
Requirements:
High School Diploma or GED
3 years years claims experience and complete understanding of all systems, policies and procedures.
Knowledge, Skills and Abilities (KSAs)
Ability to analyze information gathered from investigation, Proficient
Excellent communication skills both written and verbal., Proficient
Ability to recognize, analyze, and solve a variety of problems., Proficient
Skill in completing assignments accurately with attention to detail., Proficient
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs.
Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
