Benefit Adjuster I

AFA American Fidelity Assurance Company; Oklahoma; On-site; USD 36,000 - 60,000; Full time

Job summary

AFA American Fidelity Assurance Company is seeking a Claims Processor to evaluate and process routine claims with accuracy and care in a fast-paced environment. You will communicate with customers and medical providers, applying knowledge of CPT/ICD10 codes and medical terminology to determine coverage and payment.

This role emphasizes customer service and teamwork within the claims department. Strong analytical skills and attention to detail are essential, with a willingness to work overtime as

Qualifications

• High school diploma or GED required.
• Knowledge of medical terminology preferred.
• Proficient in Windows-based software and able to learn new applications.
• Solid understanding of anatomy and physiology.
• Familiarity with CPT and ICD-10 coding.
• Strong analytical skills and judgment.
• Excellent oral and written communication.
• Able to work in a fast-paced environment and be flexible with schedule.
• Team player with professional attitude.

Responsibilities

• Evaluates and processes routine claims such as Diagnostic Testing, Wellness, Physician Expense, URM, GAP, Hospital Indemnity, Medlink, Dental, Triage/Incomplete or Pregnancy claims according to policy and guidelines.
• Provides verbal/written communication to customers to ensure high standards of service and meets department metrics.
• Interacts with customers and medical providers, offering direction and assistance on insurance coverage and needs.

Education

High school diploma or GED

Medical terminology

Analytical skills

Oral and written communication

Team player

Flexibility

Overtime willingness

Tools

Windows OS Basics

Job description

• Evaluates and processes claims that require routine judgement and investigation such as Diagnostic Testing, Wellness, Physician Expense, URM, GAP, Hospital Indemnity, Medlink, Dental, Triage/Incomplete or Pregnancy claims in accordance with Company policy terms, insurance laws, regulatory requirements and adjusting guidelines.
• Provides appropriate verbal and/or written communication to internal and external Customers in a positive and knowledgeable manner to ensure a high standard of Customer service. Meets standards established in department performance metrics for appropriate handling of Customer phone calls.
• Acts as a direct contact and communicates with Customers and medical providers in a positive, knowledgeable and professional manner, providing them with direction and assistance in all facets of insurance coverage and needs. Education & Certification High school diploma or general education degree (GED) Technical Skills & Requirements Prompt and reliable Good medical terminology preferred Possesses General PC Windows-based software knowledge with the ability to learn new applications and work in a paperless environment Good understanding of anatomy and physiology Good contract knowledge Familiarity with CPT and ICD10 coding Possesses good analytical skills and judgment Ability to be flexible in work schedule, including a willingness to work overtime as needed Good oral and written communication skills Ability to handle fast-paced environment Professional attitude Dedicated to providing world-class Customer service Ability to work well within a team environment

#AFC Corporate Careers | Sales Careers | Internships | APL American Fidelity is a certified Great Place to Work for All! No matter where you work in the organization, you have a chance to make a difference.

Our culture focuses on helping Colleagues to be their best! We work hard to make a difference to our Customers and community, focus on teamwork and collaboration and always offer a different perspective - a different opinion. We want to meet you! American Fidelity specializes in the education, public sector, automotive and healthcare industries with products like group and individual life, health and annuity services as well as other financial security products and services. We're focused on offering a different opinion to our Customers - making things easier for them by providing benefits administration and education. For our policyholders, we help provide financial security through our benefit offerings, which provide coverage for some of life's worst events - cancer, accidents, critical illnesses, death and more - and for some of life's best - childbirth, retirement and more.