CLAIMS ADJUSTER

Company Overview The Laborers Funds Administrative Office of Northern California, Inc. is a not-for-profit corporation providing administrative services under contractual agreements for Northern California Laborers Trust Funds. We employ over 100 employees and provide services for over 30,000 Laborers and beneficiaries in the various employee benefit plans we have administered since 1963. Role Overview We are seeking a Medical Claims Adjuster to join our team and deliver outstanding administrative support and customer service to union Laborers and their families. Responsibilities Administer union-negotiated health and welfare fringe benefits by processing medical claims in a high-volume environment. Provide customer support to members and providers while ensuring compliance with plan documents and regulations. Accurately and efficiently process medical claims. Respond to correspondence and inquiries from members, dependents, and providers. Collaborate with providers and vendors to resolve claim issues. Prepare reports and assist with special tasks and projects related to claims. Respond to legal inquiries, including subpoenas. Verify and update eligibility with network vendors. Assist and resolve issues on behalf of members. Monitor and adapt to frequent changes and evolving requirements in regulations, organizational guidelines, and medical insurance policies or laws that may impact claims and operations. Independently research updates in medical coding and medical policies. Qualifications Strong organizational and communication skills. Two years of prior experience in medical claims processing and customer service. Preferred bilingual in Spanish. Ability to work independently and within a high-paced, team-oriented environment. Proficient in MS Suite (Outlook, Excel, Word) and computer systems and applications. Ability to multi‑task, prioritize and meet deadlines. Self‑motivated and remain calm under pressure. Analytical and detail‑oriented with attention to accuracy. Flexible and adaptable to changes. Ability to independently research and remain current on medical coding and policy changes. Discretion with ability to maintain confidentiality. Strong interpersonal skills in working with employees, members and other departments. Basic understanding of call center ACD and IVR systems. Benefits Medical, dental and vision coverage paid by the employer. Employer contributed employee Pension and Annuity plan. Optional participation in a 401(k) plan. Sick, vacation time, 8 major holidays, and 2 annual floating holidays under a Collective Bargaining Agreement. Conditions of Employment 150‑day probationary period. Microsoft Office Suite testing required. Work under Collective Bargaining Agreement. Union job with union dues ( Fringe benefits administered by Laborers Trust Funds ( Background check and drug testing. Work Environment Moderate noise level is typical of an office environment. Key Skills Medical claims processing. Customer service. Spanish (bilingual). Microsoft Office Suite. Medical coding. Analytical thinking. Detail-oriented. Confidentiality. Interpersonal skills. Call center systems, ACD, IVR. #J-18808-Ljbffr Y Axis Inc