Claims Adjuster - Remote / Telecommute

Cynet Systems Inc; Fairfax (VA); Remote; USD 60,000 - 80,000; Full time

Job summary

Cynet Systems Inc. recherche un spécialiste des réclamations avec plus de 5 années d'expérience pour gérer les ajustements de réclamations, assurer leur conformité aux procédures standards et analyser les informations. Le candidat idéal aura une formation de niveau secondaire et des compétences avancées en communication et en résolution de problèmes.

Qualifications

• 5+ années d'expérience en traitement des réclamations.
• Compréhension complète des systèmes, politiques et procédures.
• Capacité d'effectuer des ajustements d'exclamations

Responsibilities

• Investigation et ajustements proactifs des réclamations.
• Mise à jour des dossiers d'audit des réclamations.
• Règlement des réclamations standard/complexes.

Skills

Analyse des informations

Compétences en communication

Résolution de problèmes

Précision

Education

High School Diploma or GED

Tools

Inter-Plan Teleprocessing System (ITS)

Job description

Job Description:

Essential Functions:

• 60% Proactively investigate and perform adjustments of claims.
• Ensure claims are handled within authority limits, and in line with standard procedures and guidelines.
• 20% Updates claims audit records by entering, verifying, and securing data.
• 10% Settle standard/complex claims through payment or denial.
• 5% Provides claims audit information and reports by collecting, analyzing, and summarizing data and trends.
• 5% Improves claims adjustment job knowledge by attending training sessions

Qualifications:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• The requirements listed below are representative of the knowledge, skill, and/or ability required.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level:

• High School Diploma or GED.

Experience:

• 5+ years claims experience and complete understanding of all systems, policies and procedures.

Knowledge, Skills and Abilities:

• Experience with Inter-Plan Teleprocessing System (ITS) Claims.
• Ability to analyze information gathered from investigation.
• Excellent communication skills both written and verbal.
• Ability to recognize, analyze, and solve a variety of problems.
• Skill in completing assignments accurately with attention to detail.