Benefit Adjuster I

‎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. No prior claims experience required, you will go through an extensive training. You must be onsite for training for the first 6 months.
• 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. On average, the level I adjusters are having around 10 calls a day (not including call backs).
• 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
• Customer Service experience required
• 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
• 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