Medical Claims Adjuster

2 weeks ago

Canfield, Ohio, United States Wipro Full time

Claims Resolution Specialist

Wipro is seeking individuals who combine excellent customer service and problem-solving skills with the ability to function effectively both as part of a team or on an individual basis to bring their talent to our team.

We offer a strong compensation package that includes competitive pay and day one benefits. Wipro also offers many opportunities for career advancement within our engaging and exciting culture.

Key Responsibilities:

  • Review and adjust medical claims according to Plan guidelines within established turnaround time frames
  • Interpret medical plan to assure system is coded correctly
  • Review claims for legitimacy and accuracy
  • Meet production and quality standards set for adjusters
  • Properly assign over-payments and refunds to existing balances
  • Work Customer Service inquiries related to claim questions
  • Review correspondence submitted by members and providers and adjust all related claims if the additional documentation submitted warrants adjustment
  • Other duties as assigned

Requirements:

  • High School/GED required
  • Demonstrate skills in problem solving and benefit plan interpretation
  • Knowledge of CPT codes, ICD9/ICD10 codes and/or medical terminology is a plus
  • Ability to work independently
  • PC proficiency
  • Average typing ability

About Wipro:

Wipro is a leading global IT Solutions and Services company with over 200,000 dedicated employees serving clients across more than 66 countries.

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