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Healthcare Claims Specialist
2 months ago
MEDICAL CLAIMS ADJUSTER
Job Category: CLAIMS
Requisition Number: MEDIC01156
Job Overview
As a Medical Claims Adjuster, you will be responsible for managing and processing medical and short-term disability claims with precision and care.
Key Responsibilities:
- Evaluate and process medical claims efficiently.
- Handle a high volume of inquiries from participants and providers regarding benefits.
- Conduct regular meetings with participants to clarify benefit-related questions.
- Adhere to HIPAA compliance regulations to safeguard participant health information.
Essential Skills and Qualifications:
- A minimum of two years of experience in medical claims processing.
- Ability to interpret documents such as Summary Plan Descriptions and procedural manuals.
- Proficient in Microsoft Office and quick to learn new software applications.
- Willingness to travel up to 5% of the time.
Competencies:
- Customer Service: Responds promptly to customer needs and manages challenging situations effectively.
- Oral Communication: Communicates clearly and listens attentively to ensure understanding.
- Written Communication: Produces clear and informative written materials and edits for accuracy.
- Business Acumen: Understands the business implications of decisions and aligns work with strategic objectives.
- Professionalism: Maintains a tactful approach and accepts responsibility for actions.
- Judgment: Makes sound decisions and includes relevant stakeholders in the decision-making process.
- Quality: Strives for accuracy and thoroughness in all tasks.
- Dependability: Follows instructions and meets commitments consistently.
- Attendance/Punctuality: Maintains consistent attendance and punctuality.
- Adaptability: Adjusts to changes in the work environment and prioritizes tasks effectively.
Preferred Skills:
- Customer Service: Advanced proficiency.
- Teamwork: Intermediate proficiency.
- Adaptability: Expert proficiency.
Detail Orientation: Demonstrates capability in executing tasks with attention to detail.
Team Collaboration: Works effectively as part of a team.
Experience: At least 2 years of relevant medical claims experience is preferred.
Licenses & Certifications: Relevant certifications are advantageous.
