Claims Adjuster

Summary

The claims adjuster is responsible for the adjusting of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the IPAs. Researches, reviews and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a resource of information to all staff.

Duties and Responsibilities:

• Accurately review all incoming adjustment requests to verify necessary information is available.
• Adjust claims in accordance with departmental policies and procedures and other rules applicable to claims.
• Coordinate resolution of claims issues with other Departments.
• Assist Providers and other Departments in claims research.
• Review and adjudicate web portal inquiries.
• Assist in training claims personnel when issues are identified.
• Promote a spirit of cooperation and understanding among all personnel.
• Attend organizational meetings as required
• Adhere to organizational policies and procedures.
• Performs other tasks as assigned by supervisor/manager
• Adhere to MedPOINT Management’s core value: Accountability, Community, Celebration, Integrity, Innovation & Collaboration

• Meets production standards of 20-100 claims as established by claims management.

Minimum Job Requirements:

High school graduate. One-year experience as a Claims Examiner on an automated claims adjudication system. Strong organizational and mathematical skills. Ability to get work done efficiently and within timeliness guidelines.

Skills and Abilities Required:

• Experience in a managed care environment preferred.
• ICD-10 and CPT-4 coding knowledge preferred.
• Must be detail oriented and have the ability to work independently

Salary Range:

• $20-$23 per hour