Medical CLAIMS ADJUSTER

Medical

CLAIMS ADJUSTER

Skills

• Facets
• Insurance
• Healthcare
• Facets G6
• claims
• Medical Claims processing
• Medical Claims Adjustment
• Claims Adjustment
• Provider Refund
• Claims Adjuster
• SummaryInvestigate and perform adjustment of claims and ensure that claims are handled properly within authority limits, and in line with standard procedures and guidelines.

Verifies insurance claims by reviewing claims requirements; examining documentation and calculations; highlighting and summarizing out-of-line situations; recommending changes in operating processes; completing reports, logs, and audit records.

ESSENTIAL FUNCTIONS

60% Proactively investigate and perform adjustments of claims. Ensure claims are handled within authority limits, and in line with standard procedures and guidelines.20% Updates claims audit records by entering, verifying, and securing data.10% Settle standard/complex claims through payment or denial.5% Provides claims audit information and reports by collecting, analyzing, and summarizing data and trends.5% Improves claims adjustment job knowledge by attending training sessions1+ year of Claims Adjustment experience minimum requiredThe team are using

FACETS G6

platformMedical Claims processing experience. Medical Claims Adjustment experience. .QualificationsTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonableaccommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level:

High School Diploma or GEDExperience:

3 years years claims experience and complete understanding of all systems, policies and procedures.

Preferred QualificationsKnowledge, Skills and Abilities (KSAs)Ability to analyze information gatd from investigation, ProficientExcellent communication skills both written and verbal., ProficientAbility to recognize, analyze, and solve a variety of problems., ProficientSkill in completing assignments accurately with attention to detail., ProficientEmployers have access to artificial intelligence language tools ("AI") that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.