Claims Adjuster Join Our Team and Make a Difference for Our Members We are seeking a detail-oriented, customer-focused Claims Adjuster to join our growing team. In this role, you will be responsible for investigating, processing, and resolving member claims while providing outstanding customer service and ensuring accurate claim administration. The ideal candidate is analytical, organized, and thrives in a fast-paced environment. About the Role As a Claims Adjuster, you will manage the complete claims process from initial review through final resolution. You will work directly with members, insurance companies, hospitals, and other facilities to gather documentation, evaluate claim eligibility, and determine claim outcomes. Key Responsibilities Investigate, evaluate, and process member claims accurately and efficiently. Verify member eligibility and coverage. Communicate with members to obtain claim information and documentation. Contact insurance companies, hospitals, and medical providers to secure required records and supporting information. Review claims and make approval or denial decisions. Document claim activity and maintain accurate system records. Prepare claim payment requests and maintain payment logs. Handle member inquiries regarding claim status and decisions. Address denial disputes and member appeals professionally and effectively. Support customer service and other departments as needed. Train and mentor Claims Administrators when requested. Process daily correspondence, incoming faxes, and related administrative tasks.

Handle claims including:

Auto Deductible Reimbursement Home Deductible Reimbursement Medical Expense Reimbursement Additional claim types as assigned. Qualifications High School Diploma or equivalent. Adjuster License, preferred. Ability to study for and obtain license in first 180 days of employment if not already licensed. Basic computer proficiency. Strong analytical and problem-solving skills. Excellent verbal and written communication skills. Strong interpersonal and customer service skills. Ability to multitask and effectively prioritize workload. Conflict resolution and telephone communication skills. Working Environment Monday to Friday 8am - 5pm Frequent interaction with members requiring patience, professionalism, and effective problem resolution. Opportunity to contribute to a collaborative and service-focused team. Physical Requirements Extended periods of computer work. Repetitive administrative and claims-related tasks. Ability to sit at a workstation for prolonged periods.

Reporting Structure Reports To:

Claims Staff Supervisor May Supervise:

Claims Administrator I, based on business needs. Apply Today If you are a motivated professional who enjoys helping customers, solving problems, and ensuring accurate claims processing, we'd love to hear from you. Apply today and become part of a team dedicated to providing exceptional service and support to our members. We offer health, dental, and vision insurance, along with Life and Long-Term Disability Insurance. We also offer a 401K with an employer matching contribution, paid days off and holidays.

Pay:

$41,000.00 - $50,000.00 per year

Benefits:

401(k) 401(k) matching Dental insurance Flexible spending account Health insurance Life insurance Paid time off Vision insurance

Work Location:

In person