Medical Claims Adjuster III

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

Benefits offered by this job

3 flexible remote days per month

Half-day Fridays

On-site in Elkhorn, NE

Job summary

Guarantee Trust Life Insurance Company (GTL) in Omaha, NE, is seeking a Medical Claims Adjuster III to join our team. The role emphasizes adjudicating medical claims based on contract provisions and state guidelines, with on-site work in Elkhorn most days.

Ideal candidates have 3–5 years of medical health claim adjusting experience, strong written and verbal communication, and the ability to work in a production environment.

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. 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

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.

Skills

Attention to detail

Communication skills

Production environment experience

Phone/customer contact experience

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 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.

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. 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.

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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