Benefit Adjuster I

American Public Life Insurance Company; Oklahoma City (OK); On-site; USD 42,000 - 62,000; Full time

Job summary

American Fidelity is seeking a claims processor to evaluate and process 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, insurance laws and adjusting guidelines.

You will communicate with customers and medical providers to provide direction and assistance in coverage and needs, maintaining a professional, positive demeanor in all interactions and adhering

Qualifications

• High school diploma or GED required.
• Good medical terminology preferred.
• Able to learn new applications in a paperless environment.

Responsibilities

• Evaluates and processes routine claims such as Diagnostic Testing, Wellness, Physician Expense, URM, GAP, Hospital Indemnity, Medlink, Dental, Triage/Incomplete or Pregnancy claims.
• Provides verbal and/or written communication to customers and medical providers to ensure high standard of customer service.

Skills

Medical terminology

Analytical skills

Communication skills

Teamwork

Education

High school diploma or GED

Tools

Windows-based PC software

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.