Medical Claims Adjuster

Position Title Medical Claims Adjustor Position Summary The Medical Claims Adjustor provides customer service and processes routine health and welfare claims on assigned accounts according to plan guidelines while adhering to company policies and regulatory requirements. The role has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII). Key Duties and Responsibilities Maintain current knowledge of assigned plan(s) and effectively apply that knowledge in the payment of claims. Process routine claims which may include medical, dental, vision, prescription, death, life and AD&D, workers' compensation, or disability. Provide customer service by responding to and documenting telephone, written, electronic, or in-person inquiries. Perform other duties as assigned. Minimum Qualifications High school diploma or GED. Six months of experience processing health and welfare claims. Basic knowledge of benefits claims adjudication principles and procedures, medical and/or dental terminology, ICD-10 and CPT-4 codes. Strong work ethic and team‑player mentality. High sense of integrity and commitment to customer satisfaction. Ability to communicate clearly and professionally, both verbally and in writing. Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations. Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages. Ability to work in an environment with shifting priorities and to handle a wide variety of activities and confidential matters with discretion. Computer proficiency, including Microsoft Office tools and applications. Preferred Qualifications Experience working in a third‑party administrator. Compensation $19.00 per hour (location specific). #J-18808-Ljbffr