Benefit Adj I-1

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• 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.
• 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.
• 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
• 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
• Familiarity with CPT and ICD10 coding
• 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

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