Medical Claims Adjuster III

Guarantee Trust Life Insurance Company; Glenview (IL); Hybrid; USD 39,000 - 48,000; Full time

Benefits offered by this job

Medical

Health Savings Account (employer贡献)

Dental

Vision

Life Insurance

Disability

Paid Holidays

Paid time off

401(k) and matching

Profit-Sharing Retirement Plan

Job summary

Guarantee Trust Life Insurance Company (GTL) is seeking a Medical Claims Adjuster III to join our team in Glenview, IL. The role focuses on adjudicating medical health claims with attention to policy language and carrier guidelines.

On-site most days with three flexible remote days per month and half-day Fridays. You will evaluate claims (home health, long-term care, cancer, heart attack, stroke), communicate decisions to providers, and maintain production metrics.

Qualifications

• 3–5 years of medical health claim adjusting experience.
• Experience with Short-Term Home Health Care, Long Term Care, and cancer/heart/stroke claims.
• Strong written and verbal communication; ability to handle calls with insureds, providers and physicians.

Responsibilities

• Adjudicate claims based on contract provisions and state guidelines.
• Interpret policy language and reference health care terminology.
• Communicate coverage determinations, claim payments, denials, appeals and documentation requests.
• Maintain quality and production metrics within a fast-paced environment.

Skills

Medical claims adjusting

Communication skills

Phone support

Attention to detail

Production targets

Job description

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 Gelnview, IL 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.

Qualifications

What 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:

• Medical
• Health Savings Account (including employer contribution)
• Dental
• Vision
• Basic Life Insurance (full premium paid by employer)
• Voluntary Employee, Spouse and Child Life Insurance
• Short-Term and Long-Term Disability
• Paid Holidays
• Paid time off including vacation, personal days, sick time and Flex Fridays
• 401(k), 401(k) Match and Profit-Sharing Retirement Plan

We invite you to learn more about Guarantee Trust Life by visiting our website: www.gtlic.com

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