Job Brief
As a Health Insurance Adjuster, you will play a crucial role in managing and reviewing insurance claims to ensure compliance with company policies and industry regulations. Your primary responsibilities will involve evaluating settled claims, determining payment accuracy, and collaborating with legal teams on complex cases that may require litigation. A successful candidate will possess strong analytical skills, attention to detail, and a thorough understanding of health insurance policies and procedures.
Responsibilities
- Review and analyze settled claims to verify compliance with company practices and regulatory standards.
- Assess claim documentation to ensure accurate payments and settlements.
- Collaborate with legal counsel on claims that may involve litigation or require legal interpretation.
- Negotiate and settle insurance claims as necessary, adhering to established guidelines.
- Maintain detailed records of claims processing activities and outcomes.
- Provide exceptional customer service by addressing inquiries and resolving issues related to claims.
- Stay updated on industry trends, regulations, and best practices in health insurance.
Requirements
- Bachelor’s degree in a relevant field, such as finance, business administration, or healthcare.
- Proven experience as an insurance adjuster, preferably in health insurance claims.
- Strong knowledge of health insurance policies, regulations, and compliance standards.
- Exceptional analytical and problem-solving skills with a keen attention to detail.
- Excellent communication and interpersonal skills for effective negotiation and collaboration.
- Familiarity with claims management software and tools.
- Relevant certifications, such as the Associate in Claims (AIC) or similar, are a plus.
Similar Job Titles
- Claims Adjuster
- Insurance Claims Specialist
- Health Claims Examiner
- Insurance Adjuster
- Claims Analyst
- Insurance Appraiser
- Health Insurance Specialist
- Claims Processing Agent
