Benefit Adjuster I

American Fidelity; Oklahoma City (OK); On-site; USD 45,000 - 65,000; Full time

Job summary

American Fidelity is seeking a Claims Representative to evaluate and process routine claims in line with policy terms and regulations. You will communicate with customers and medical providers to provide guidance on coverage and next steps.

The role requires a high school diploma or GED, strong medical terminology knowledge, and excellent written and verbal communication. You will work in a team-oriented, fast-paced environment in Oklahoma City, with opportunities to learn and grow within the

Qualifications

• High school diploma or GED required.

Responsibilities

• Evaluates and processes routine claims such as Diagnostic Testing, Wellness, Physician Expense, URM, GAP, Hospital Indemnity, Medlink, Dental, Triage/Incomplete or Pregnancy claims in accordance with policy terms and guidelines.
• Provides verbal and/or written communication to customers to ensure high standards of customer service and adheres to department performance metrics.
• Acts as a direct contact with customers and medical providers, offering direction and assistance on insurance coverage and needs.

Skills

Prompt and reliable

Medical terminology

CPT and ICD10 coding

Analytical skills and judgment

Flexible schedule / overtime

Oral and written communication

Thrives in fast-paced environment

Professional attitude

Customer service mindset

Teamwork

Education

High school diploma or GED

Tools

Windows-based software proficiency

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

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