Claims Adjuster
1 week ago
**Claims Adjuster**
Dolphin Drive - Waukesha County, 1801 Dolphin Drive, Waukesha, Wisconsin, United States of America Req #1894 Monday, February 7, 2022 ***Community Care has adopted a mandatory COVID-19 vaccination policy. This policy requires that all Community Care, Inc. employees verify they are fully vaccinated or have an approved medical or religious exemption.*** Community Care is hiring a Claims Adjuster. This rewarding opportunity is perfect for someone who enjoys team collaboration, being part of a mission driven organization and who shares our mission to help elderly individuals and adults with physical and intellectual disabilities continue to live as independently as possible in the community. This is a full-time opportunity at our Waukesha Office.
Claims Adjuster Job Responsibilities :
Claims Analysis/Resolution
Assists staff with analysis and resolution of complex claims and reimbursements.
Call Center Coverage
Provides back up coverage to the call center Customer Service Representatives (CSRs) as needed.
Claims Processing
Processes claims and issues payment authorizations as assigned.
Claims Investigation and Resolution
Receives, researches, resolves, tracks and documents claims related inquiries and informal grievances from providers, internal departments and external agencies within the timeframes of established performance standards and in an accurate and professional manner. Utilizes appropriate resources to respond to provider inquiries. Performs simple claim adjustments needed to resolve inquiries. Maintains good working relationships and open communication with internal and external customers.
Resolving Provider Issues
Assists with resolving provider issues and answering provider questions related to contracts and claims.
Productivity Tracking
Provides routine reporting of work volume and productivity as required.
Performs other job-related duties as assigned.
Claims Adjuster Experience : Minimum of three years of claims processing experience in an environment of multiple plan benefits and provider contracts required. Two to three years of Customer Service experience is desired.
Claims Adjuster Education : High School diploma required.
Monday to Friday
8:00 AM 4:30 PM Hybrid schedule may be available
Community Care is a nonprofit organization with over 40 years of experience helping adults with long-term care needs live as independently as possible. Our Medicare/Medicaid long-term care programs serve the needs of older adults and adults with disabilities. We coordinate and deliver a full range of supportive services that help them live safely, confidently and with dignity.
More than 12,000 Wisconsinites trust in us to provide the quality support needed to help them reach their potential in health, happiness and independence. We are Wisconsin-based and have local offices supporting each of the 15 counties we serve.
Compensation and Benefits:
Our employees make a real difference in peoples lives every day. To show appreciation, were dedicated to offering competitive pay and a comprehensive benefits package to our staff that addresses their mental, physical and financial health and well-being.
If interested in joining Community Care, please apply and our recruitment team will reach out promptly.
**Other details**
* Job Family Finance - Accounting
* Halogen Template Staff Business Support
* Pay Type Hourly
