Medical Claims Adjuster III

GUARANTEE TRUST LIFE INS CO

Elkhorn (WI)

On-site

USD 39,000 - 48,000

Full time

14 days+

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Benefits offered by this job

Medical

HSA (Health Savings Account)

Dental

Vision

Basic Life Insurance

Voluntary Life Insurance

Disability

Paid Holidays

PTO including vacation, personal days,

401(k)

Profit-Sharing

Job summary

Guarantee Trust Life Insurance Company (GTL) is seeking a Medical Claims Adjuster III to join our team in Elkhorn, NE. This full-time, on-site role requires adjudicating claims based on contract provisions and state guidelines, with knowledge of policy language and medical terminology.

The position offers competitive hourly pay of $28.00-$35.00, typically with most days on-site and three flexible remote days per month, plus half-day Fridays. Excellent communication and accuracy are essential.

Qualifications

3-5 years of medical health claim adjusting experience, preferably prior experience with Short-Term Home Health Care, Long Term Care, and/or Cancer/Heart Attack/Stroke claims.
Experience reading and referencing policy language for benefit administration.
Experience investigating and adjusting contestable claims.
Strong experience composing clear, professional correspondence and letters to customers, physicians, and healthcare providers related to coverage determinations, claim payments, denial notifications, appeals, and documentation requests.
Experience handling difficult phone calls from insureds, family members, and healthcare providers. Inbound and outbound calls required.
Strong attention to detail and good judgement.
Ability to work within a production environment with quantity and quality metrics.

Responsibilities

Adjudicate claims based on contract provisions and state guidelines.
Understand policy contract language, insurance applications, medical terminology, and medical aspects.

Skills

Medical claims adjusting

Policy language comprehension

Communication skills

Phone handling

Attention to detail

Production environment

Job description

Job Details

Job Location: GTL Nebraska Office - Elkhorn, NE 68022

Position Type: Full Time

Salary Range: $28.00 - $35.00 Hourly

Guarantee Trust Life Insurance Company (GTL) is currently seeking a Medical Claims Adjuster III to join our team!

Since 1936, GTL has offered cutting-edge insurance solutions and personalized service for our policyholders and distributors, while supporting personal growth and civic involvement from our employees. We’re seeking candidates who are looking for meaningful work, who want to invest in their growth, and contribute to a company built on timeless virtues and best business practices.

This position is required to work on-site in our Elkhorn, NE office most days. Everyone receives 3 flexible remote days per month. And, we offer half-day Fridays – every Friday!

Summary of Responsibilities:

The primary responsibilities are to adjudicate claims based on variable contract provisions and benefits according to state guidelines. The person in this position must understand policy contract language, insurance applications, medical terminology, and medical aspects.

QualificationsWhat you should bring to the table:

3-5 years of medical health claim adjusting experience, preferably prior experience with Short-Term Home Health Care, Long Term Care, and/or Cancer/Heart Attack/Stroke claims.

Experience reading and referencing policy language for benefit administration.

Experience investigating and adjusting contestable claims.

Strong experience composing clear, professional correspondence and letters to customers, physicians, and healthcare providers related to coverage determinations, claim payments, denial notifications, appeals, and documentation requests.

Experience handling difficult phone calls from insureds, family members, and healthcare providers. This position does require you to take inbound calls and make outbound calls.

Strong attention to detail and good judgement.

Ability to work within a production environment. Ability to maintain proper Quantity and Quality metrics while working within this production environment.

Strong verbal and written communication skills.

Pay range for this role is $28-$35 per hour, commensurate with experience

The pay range provided is not a guarantee of compensation. The range reflects potential pay for the job grade for this role at the time of this posting. Compensation will depend on several factors such as specific competencies, relevant education and experience, qualifications, and industry certifications. Compensation ranges are subject to change and may be higher or lower than the range described above.

Provided eligibility requirements are met employees will be eligible for the following benefits: