Job Details

Job Description:
Our client is seeking a Claims Adjuster to manage a personal queue of medical claims, verify coverage and interact with healthcare providers to obtain necessary documentation.

Responsibilities:

• Manage a personal queue of assigned medical claims.
• Verify coverage and maintain accurate records for all claims.
• Interact with healthcare providers to obtain necessary documentation.
• Approve claims for payment in accordance with departmental guidelines.
• Proactively communicate with members regarding their claims, including explanations of the claim adjudication process.
• Set up and scan new claims for processing.
• Deliver exceptional support to members, providers and other departments via phone, email and chat.
• Exhibit attention to detail, empathy and strong active listening skills in all interactions.
• Serve as a knowledgeable resource on the client’s products, including member benefit coverage.
• Understand and adhere to insurance regulatory requirements.

Requirements:

• 2+ years of experience in medical claims processing with a biller (hospital or physician practice) or an insurance company (property and casualty claims experience is not applicable)
• Familiarity with Explanation of Benefits forms from primary insurance companies and Health Insurance Claim Forms (HCFA/1500 forms)
• 2+ years of experience in medical workers' compensation or bodily injury claims
• Current Florida 6-20 All Lines Adjuster License
• High school diploma or equivalent
• Previous customer service experience with strong verbal and written communication skills
• Ability to organize, prioritize and execute work effectively to meet established claim/recovery service standards and benchmarks

Contact:
Marianna Zalova
+1 (312) 884-0414
mzalova@jacobsononline.com


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