Job Title: Claims Adjuster 1
After the established training period and under close supervision, this position adjudicates Long Term Care Insurance claims. Work involves the interpretation of insurance contracts and benefit schedules, and requires sound judgment, accurate computation ability, and the ability to make routine decisions independently. This position requires a commitment to meeting team and departmental goals and internal and regulatory standards. The appropriate handling of PHI and excellent communication and customer service skills are required.
- Manages assigned claim caseload under close supervision and within normal business hours.
- Understands and consistently utilizes available resources in determining and managing claim direction
- Maintains 99% or better overall accuracy, as measured by formal audit and Supervisors’ work review.
- Meets Internal and Regulatory time standards, as measured by formal audit, and Supervisors’ work review.
- Handles PHI appropriately, adhering to HIPAA regulations and Company standards.
- Makes routine decisions independently.
- Attends staff meetings, employee development sessions and works on special projects as assigned.
- Upholds performance standards
- Performs all job duties in accordance with deadlines established by management
- Performs all job duties in accordance with departmental standards for accuracy, quality and productivity
Prerequisites for the Job:
- Minimum 2 years previous experience in long term care or disability claims experience or equivalent.
- College degree preferred.
- Proficiency in oral and written English language communication
- Willingness to work cooperatively with others
- Able to manage multiple tasks and projects under time constraints
- Previous experience using email, Internet, Windows and Microsoft Office and other applicable computer systems
- Well organized
- High school diploma or GED
- Physical and mental requirements for General Office personnel
All candidates must show proof of COVID-19 vaccination upon offer given, or become vaccinated after offer is given.
Please send resume to: firstname.lastname@example.org