Job Details

Job Description:

Essential Functions:

• 60% Proactively investigate and perform adjustments of claims.
• Ensure claims are handled within authority limits, and in line with standard procedures and guidelines.
• 20% Updates claims audit records by entering, verifying, and securing data.
• 10% Settle standard/complex claims through payment or denial.
• 5% Provides claims audit information and reports by collecting, analyzing, and summarizing data and trends.
• 5% Improves claims adjustment job knowledge by attending training sessions

Qualifications:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• The requirements listed below are representative of the knowledge, skill, and/or ability required.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level:

• High School Diploma or GED.

Experience:

• 5+ years claims experience and complete understanding of all systems, policies and procedures.

Knowledge, Skills and Abilities:

• Experience with Inter-Plan Teleprocessing System (ITS) Claims.
• bility to analyze information gathered from investigation.
• Excellent communication skills both written and verbal.
• bility to recognize, analyze, and solve a variety of problems.
• Skill in completing assignments accurately with attention to detail.