Health Claims Adjuster
|Title:||Health Claims Adjuster|
DescriptionGroup Management Services (GMS) located in Richfield, Ohio is seeking to hire a full-time Claims Adjuster for our TPA Services.
The medical Claims Adjuster is responsible for analyzing and correctly adjudicating claims for GMS TPA operations.
- Process claims adjudication
- Identify claims to be processed in order of identified importance and work within time limitations.
- Investigate and process all adjustments
- Investigate and research problem claims
- Resolve issues and identify customer needs (call on issues if missing information or additional info needed)
- Verify correct plan loading (making sure claim is processed according to the clients plan)
- Follow up with pended claims
- Pull claims for auditing
- Maintain daily paid claims workload
- Adjudicate claims and prescriptions for outside vendors
- Investigate all code review output for a claim and correctly processes according to set procedures
- Pull pended claims over 30 days old and processes accordingly
- Investigate and resolve outstanding issues on behalf of the member by communicating with applicable departments and responding to the member.
- Initiate claim adjustments, additional ID card replacements, duplicate EOB’s, canceled check requests, etc.
• Minimum high school diploma or equivalent required along with 3-5 years experience in
health benefits account management or college degree.
• Exceptional customer service skills
Compensation & Benefits
- Compensation based on experience
- Benefits – Medical, Dental, Vision, 401(k), Short Term Disability, Long Term Disability, Tuition Assistance, PTO
- Other Great Perks: Cell phone reimbursement and gym membership reimbursement.
- Great work/life balance – Flex time after 90 day, Work from home capabilities
This opening is closed and is no longer accepting applications