Medical Claims Adjuster

To Apply for this Job Click Here You are a detail-oriented and customer-focused Medical Claims Adjuster responsible for administering union-negotiated health and welfare benefits while providing exceptional support to members, dependents, and healthcare providers. This position requires strong communication skills, accuracy in claims processing, and the ability to navigate medical policies, coding requirements, and benefit regulations in a fast-paced environment. This position pays: $33.45 – $36.86 What you will be doing: Process medical claims accurately and efficiently while ensuring compliance with plan documents, policies, and regulations. Provide excellent customer service to union members, families, providers, and vendors through phone and in-person interactions. Review, research, and resolve claim-related issues, eligibility questions, and benefit inquiries. Communicate benefit information, policies, and procedures clearly to members and providers. Collaborate with healthcare providers and vendors to resolve discrepancies and ensure timely claim resolution. Respond to written correspondence, member inquiries, legal requests, and subpoenas as needed. Prepare reports, update eligibility information, and assist with claims-related projects and special assignments. Stay current on medical coding updates, insurance policies, and regulatory changes impacting claims operations. Maintain confidentiality while handling sensitive member and medical information. Manage multiple priorities while meeting deadlines in a high-volume claims environment. What you bring: 2+ years of experience in medical claims processing and customer service. Strong organizational skills with excellent attention to detail and accuracy. Ability to work independently while contributing to a collaborative, team-focused environment. Bilingual Spanish skills preferred. Proficiency with Microsoft Office Suite, including Outlook, Word, and Excel. Strong computer skills and ability to learn new systems and applications. Ability to multitask, prioritize workload, and remain calm under pressure. Analytical mindset with strong problem-solving and research skills. Ability to adapt to changing regulations, policies, and procedures. Knowledge of medical coding and insurance processes. Excellent interpersonal and communication skills when working with members, providers, and internal teams. Familiarity with call center systems, including ACD and IVR platforms. Ability to maintain discretion and confidentiality with sensitive information. Work Environment: Professional office setting with a moderate noise level and frequent interaction with members, providers, and team members. #J-18808-Ljbffr