Health Insurance Claims Adjuster

Job Summary

Analyze claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines. Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions. Coordinate daily workflow to coincide with check cycle days to meet all service guarantees. Maintain external contacts with policyholders, providers of service, agents, attorneys and other carriers as well as internal contacts with peers, management, and other support areas with a positive and professional approach.

Primary Responsibilities: 

• Examine/perform/research & make decisions necessary to properly adjudicate claims and written inquiries.
• Interpret contract benefits in accordance with specific claim processing guidelines.
• Understand broad strategic concept of our business and link these to the day-to-day...