Claims Adjuster handling Errors & Omissions and Professional Indemnity claims for a leading insurance provider. Collaborating with various teams to ensure excellent claims service delivery.
About the role
- Claims Examiner processing and adjudicating healthcare claims at WebTPA. Involves claims research and verifying insurance coverage in a customer service role.
Responsibilities
- Day-to-day processing of claims for accounts:
- Responsible for processing of claims (medical, dental, vision, and mental health claims)
- Claims processing and adjudication.
- Claims research where applicable.
- Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic).
- Incumbents are expected to meet and/or exceed qualitative and quantitative production standards.
- Investigation and overpayment administration:
- Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers.
- Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records.
- Utilize systems to track complaints and resolutions.
- Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading.
Requirements
- 2+ years related work experience.
- Claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry.
- High school diploma or GED
- Knowledge of CPT and ICD-9 coding required.
- Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits required.
- Must possess proven judgment, decision-making skills and the ability to analyze.
- Ability to learn quickly and multitask.
- Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers.
- Concise written and verbal communication skills required, including the ability to handle conflict.
- Proficiency using Microsoft Windows and Word, Excel and customized programs for medical CPT coding.
- Review of multiple surgical procedures and establishment of reasonable and customary fees.
Benefits
- Medical, dental, vision, life and global travel health insurance
- Income protection benefits: life insurance, Short- and long-term disability programs
- Leave programs to support personal circumstances.
- Retirement Savings Plan includes employer contribution and employer match
- Paid time off, volunteer time off, and 11 holidays
- Additional voluntary benefits available and a comprehensive wellness program
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
Process low level general liability claims for a global leader in risk and claims administration. Ensure ongoing adjudication of claims within standards while maintaining professional client relationships.
Claims Examiner adjudicating Lost - Time Workers Compensation claims at Sedgwick. Analyzing claims, ensuring timely resolutions, and negotiating settlements for clients' claims.
Analyzing and managing general liability claims for Sedgwick, upholding industry standards and ensuring accurate adjudication. Collaboration with clients and effective negotiation to resolve claims.
Claims Consultant in London managing Construction and Delay insurance claims. Collaborating with Insurers, Loss Adjusters, and clients while ensuring successful claim settlements.
Auto Claims Examiner responsible for investigation and resolution of commercial auto claims at Arch Insurance. Collaborates on repair processes and coordinates with body shops nationwide.
Claims Adjuster I handling Vehicle Service Contracts at MAPFRE's Claims Department. Requires remote or hybrid work arrangement in Albuquerque, New Mexico with automotive industry experience.
Medical Claims Coordinator at IVI RMA managing insurance claims in Basking Ridge, NJ. Responsible for processing, submitting, and resolving claims with insurance companies.
Senior Claims Examiner at ICW Group managing complex workers' compensation claims with a focus on service excellence. Collaborating with teams and ensuring compliance with regulations and company standards.
RV Mechanical Claims Adjuster at APCO Holdings reviewing and processing claims for RV mechanical breakdowns. Utilizing technical knowledge to assist customers and facilitate repairs.