Job Title Pay Range: $20.75/hr - $25.75/hr
Requirement/Must Have: 3+ years claims experience and complete understanding of all systems, policies and procedures.
High School Diploma or GED.
Responsibilities: Proactively investigate and perform adjustments of claims. Ensure claims are handled within authority limits, and in line with standard procedures and guidelines.
Updates claims audit records by entering, verifying, and securing data.
Settle standard/complex claims through payment or denial.
Provides claims audit information and reports by collecting, analyzing, and summarizing data and trends.
Improves claims adjustment job knowledge by attending training sessions.
Nice to Have: Medical Claims processing experience.
Medical Claims Adjustment experience.
Medical Terminology, Provider Refund.
Subrogation, Workers Comp.
Disbursements.
Skills: Ability to analyze information gathered from investigation.
Excellent communication skills both written and verbal.
Ability to recognize, analyze, and solve a variety of problems.
Skill in completing assignments accurately with attention to detail.