Adjuster, Claims

JOB DESCRIPTION Job Summary Provides support for claims adjustment activities including administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Also monitors and controls backlog and workflow of claims, and ensures that claims are settled in a timely fashion and in accordance with cost-control standards. Essential Job Duties • Researches claims tracers, adjustments and resubmissions. • Assists with defect reduction by identifying and communicating claims error issues and potential solutions to leadership. • Adjudicates or readjudicates claims in a timely manner. • Meets claims department quality and production standards. • Supports claims department initiatives to improve overall claims function efficiency. • Completes basic claims projects as assigned. Required Qualifications • At least 1 year of claims processing experience in a managed care setting, or equivalent combinat...