Claims Adjudicator

Job Description

Job Description

For over 35 years, Benefits Administration Services (BAS) has provided innovative and customized services and solutions to employers.

From health and benefit management services to human resources and payroll administration, BAS improves productivity and outcomes using advanced technology and excellent customer service. www.baslimited.com

BAS is looking for a Claims Adjudicator to provide superb customer service and claims management to members and medical providers.

SUMMARY :

Responsible for processing claims for multiple groups for medical, dental, and vision benefits. Communicates with plan sponsors regarding claims as well as the employees or providers on questions that may arise.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Processes medical, dental, and vision benefits for multiple groups.
• Send claims for repricing if needed
• Answers questions regarding coverage and claims procedures for group sponsors, employees, and providers.
• Ensures compliance with all federal programs such as HIPAA and COBRA
• Timely response to all client / employee inquiries and complaints to ensure quick, equitable and courteous resolution.
• Provide forms and other claims related materials upon request to clients / employees.
• Assist in various claims research requests to assist in developing and preparing reports, letters and spreadsheets.
• Process checks for claims and distribute per company policy.

QUALIFICATIONS- EXPERIENCE & EDUCATION

Required (Minimum) Qualifications :

• High school diploma or equivalent
• Two years of benefits experience processing claims
• Highly developed sense of integrity and commitment to customer satisfaction
• Ability to communicate clearly and professionally, both verbally and in writing
• Ability to seek positive resolution to complaints
• Strong analytical abilities and critical thinking capabilities
• Need basic knowledge of relevant laws and regulations applicable to benefit plans
• Must possess "team player" mentality
• Proficient in all Microsoft Office software
• Need basic knowledge of relevant laws and regulations applicable to COBRA, HIPAA, and the Affordable Care Act.

Benefit Administration Services is an Equal Opportunity Employer and Prohibits Discrimination and Harassment of Any Kind : Bas is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment.

All employment decisions at Bas are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and / or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.

Bas will not tolerate discrimination or harassment based on any of these characteristics. Bas encourages applicants of all ages