Claims

Job Title: Claims Adjuster 2

Position Summary:

Under general supervision, this position adjudicates Long Term Care Insurance claims. Work involves the interpretation of insurance contracts and benefit schedules, and requires excellent judgment, and accurate computation ability, the ability to make routine decisions independently and complex decisions with minimal direction. This position requires commitment to meeting team and departmental goals and a sense of urgency in meeting internal and regulatory time requirements. The appropriate handling of PHI, and excellent communication and customer service skills are required, as well as the ability to foster sound, amicable relationships with internal and external customers. Work involves motivating and being a positive role model for others.

Primary Responsibilities:

  1. Manages assigned claim caseload under general supervision and within normal business hours.
  2. Understands and consistently utilizes available resources in determining and managing claim direction
  3. Maintains 99% or better overall accuracy, as measured by formal audit and Supervisors’ work review.
  4. Demonstrates a purposeful, steady pursuit (sense of urgency) in meeting Internal and Regulatory time standards, as measured by formal audit, and Supervisor’s work review.
  5. Handles PHI appropriately, adhering to HIPAA regulations and Company standards.
  6. Makes routine decisions independently and complex decisions with minimal direction.
  7. Attends staff meetings, employee development sessions and works on special projects as assigned.
  8. 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:

All candidates must show proof of COVID-19 vaccination upon offer given, or become vaccinated after offer is given.

Please send resume to: jobsnow@lifecareassurance.com


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