MEDICAL CLAIMS ADJUSTER

MEDICAL CLAIMS ADJUSTER

Job Category : CLAIMS Requisition Number : MEDIC01142 Showing 1 location Job Details

Description

Essential Duties and Responsibilities :

• Processes medical and short-term disability claims.
• Answers high volume telephone calls from participants and providers with benefit questions.
• Meets with participants on a regular basis to answer benefit questions.
• Follow all HIPAA compliance guidelines to ensure protection of participant protected health information.
• Other duties may be assigned.

Essential Skills and Qualifications :

• Minimum of two years medical claims paying experience.
• Ability to read and interpret documents such as Summary Plan Description and procedure manuals.
• Computer Skills : Proficiency with Microsoft Office. Quick learner of other computer applications.
• Limited travel opportunities for training purposes.

Individuals should demonstrate the following competencies :

• Customer Service- Responds promptly to customers needs; Responds to requests for service and assistance; Manages difficult or emotional customer situations.
• Oral Communication- Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification;

Responds well to questions.

Written Communication- Writes clearly and informatively; Edits work for spelling and grammar; Presents numerical data effectively;

Able to read and interpret written information.

• Business Acumen- Understands business implications of decisions; Aligns work with strategic goals.
• Professionalism- Approaches others in a tactful manner; Reacts well under pressure; Accepts responsibilities for own actions;

Follows through on commitments; Team Player.

Judgment- Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions;

Includes appropriate people in decision-making process; Makes timely decisions.

Quality- Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance;

Monitors own work to ensure quality; Takes pride in his / her own work.

• Quantity- Meets productivity standards; Completes work in timely manner; Strives to increase productivity; works quickly.
• Dependability- Follows instructions, responds to management direction; Keeps commitments; Takes responsibility for own actions.
• Attendance / Punctuality- Is consistently at work and on time; Ensures work responsibilities are covered when absent.
• Adaptability- Adapts to changes in the work environment; Able to deal with frequent change, delays, or unexpected events;

Ability to prioritize duties.

Planning / Organization- Prioritizes and plans work activities; Uses time efficiently.

Skills

Preferred

COMMUNICATION *Advanced* ADAPTABILITY *Expert* CUSTOMER SERVICE *Expert* TEAMWORK *Expert* Dedicated : Devoted to a task or purpose with loyalty or integrity Education

Experience

Required

2 years : 2 years of Medical Claims experience