Medical Claims Adjustor

About the role

The Medical Claims Adjustor provides customer service and processes routine health and welfare claims on assigned accounts according to plan guidelines and adhering to Company policies and regulatory requirements. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."

Responsibilities

• Maintains current knowledge of assigned Plan(s) and effectively applies that knowledge in the payment of claims.
• Processes routine claims which could include medical, dental, vision, prescription, or Workers' Compensation.
• May provide customer service by sending out pending letters.
• Performs other duties as assigned.

Requirements

• High school diploma or GED.
• Six months of experience processing health and welfare claims.
• Basic knowledge of benefits claims adjudication principles and procedures and medical and/or dental terminology and ICD-10 and CPT-4 codes.
• Possesses a strong work ethic and team player mentality.
• Highly developed sense of integrity and commitment to customer satisfaction.
• Ability to communicate clearly and professionally, both verbally and in writing.
• Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations.
• Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages.
• Must be able to work in environment with shifting priorities and to handle a wide variety of activities and confidential matters with discretion.
• Computer proficiency including Microsoft Office tools and applications.

Qualifications

• Experience working in a third-party administrator (preferred).

Benefits

• Health, vision, and dental coverage
• Retirement savings 401(k) plan with company match
• Paid time off (PTO)
• Great opportunities for growth

Pay

Compensation: $19.00/hr