Medical Claims Adjuster

Found in: Resume Library US A2 - 2 weeks ago

Salt Lake City Utah, United States Utah Retirement Systems Full time
About The Company:
PEHP Health & Benefits is a division of the Utah Retirement Systems that proudly serves Utah’s public employees through high quality and competitively priced medical, dental, life, and long-term disability insurance plans on a self-funded basis. As a government entity, we embrace both a public mission and a commitment to creating customer value, excelling in the market, and improving healthcare. We offer a competitive salary with generous benefits, personal development in a positive team environment, and excellent work-life balance.

Job Description:
POSITION SUMMARY

This position plays a critical role in PEHP’s efforts to serve and create value for our members by processing a variety of medical claims proficiently and timely. The position includes a variety of professional duties related to processing claims. Successful performance for this position requires an attention to detail, the ability to learn complex claims processes while managing multiple diverse tasks, and a high level of commitment and dependability.

 

ESSENTIAL JOB FUNCTIONS AND DUTIES

Receives and enters medical and/or Medicare claims for payment under medical and/or Medicare Supplement plans.

Reviews claims for accuracy and completeness, verifies coverage and eligibility of patient.

Adjudicates routine and complex claims according to established policy guidelines.

Processes coordination of benefits on Medical and Dental claims.

Maintains strict confidentiality.

Performs other related duties as required.

Required Experience:
Education and Experience

High School diploma and one (1) year of work experience.

 

Specific experience in claims processing, and various administrative functions is preferred, or an equivalent combination of education and experience.

 

Knowledge, Skills, and Abilities

This list contains knowledge, skills, and abilities that are typically associated with the job. It is not all-inclusive and may vary from position to position:

 

Requires working knowledge of:

Intricacies related to medical, dental, pharmacy, and Medicare Supplement claims.

Procedures and processes; intricacies related to medical, mental health and chiropractic claims

CPT, ICD-10-CM and HCPC’s coding and medical terminology

Various office management systems related to alpha and numeric record keeping

Personal computer operations and various program applications

Some knowledge of 10 key operation

Mathematical skills

Must possess excellent communication skills:

Interpersonal communication skills; telephone etiquette

Communicate effectively verbally and in writing

Must have the ability to:

Analyze a variety of routine claims management issues and problems and make routine corrections

Maintain a strong attention to detail.

Follow written and verbal instructions.

Prioritize work, multi-task, follow through with assignments, and perform within deadlines.

Deal effectively with stress caused by workload and time deadlines.

Work well in a team environment as well as independently.

Follow through with assignments.

Work Environment

Incumbent performs in a typical office setting with appropriate climate controls. Tasks require a variety of physical activities which do not generally involve muscular strain, but do require activities related to walking, standing, stooping, sitting, reaching, talking, hearing and seeing.  Common eye, hand, finger dexterity required to perform essential functions. 

 

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