Representative, Benefits Adjuster I

American Fidelity; Oklahoma City (OK); On-site; USD 36,000 - 48,000; Full time

Job summary

A leading insurance provider in Oklahoma City is seeking an entry-level claims processor. The role involves evaluating and processing various types of claims while maintaining high customer service standards. Candidates must possess a high school diploma and have strong analytical and communication skills. This full-time position offers a dynamic work environment with opportunities for growth.

Qualifications

• High school diploma or GED required.
• Strong communication and customer service skills.
• Ability to work well in a team environment.
• Analytical thinking and problem-solving abilities.
• Familiarity with medical terminology and insurance concepts.

Responsibilities

• Evaluates and processes routine claims with judgement and investigation.
• Provides communication to customers ensuring high standards.
• Acts as a contact for customers and providers offering direction.

Skills

Prompt and reliable

Good medical terminology

General PC Windows software knowledge

Understanding of anatomy and physiology

Good contract knowledge

Familiarity with CPT and ICD10 coding

Good analytical skills

Oral and written communication skills

Ability to handle fast-paced environment

Professional attitude

Teamwork skills

Education

High school diploma or GED

Job description

Responsibilities

• 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

Seniority Level

• Entry level

Employment Type

• Full-time

Job Function

• Human Resources

Industries

• Insurance