Adjuster

&lt;p&gt; &lt;/p&gt;&lt;p&gt;* 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.&lt;/p&gt;&lt;p&gt;* 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.&lt;/p&gt;&lt;p&gt;* 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. &lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;&lt;u&gt;&lt;b&gt;Education &amp;amp; Certification&lt;/b&gt;&lt;/u&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;&lt;span&gt;High school diploma or general education degree (GED) &lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;&lt;u&gt;&lt;b&gt;Technical Skills &amp;amp; Requirements &lt;/b&gt;&lt;/u&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;Prompt and reliable&lt;/li&gt;&lt;li&gt;Good medical terminology preferred &lt;/li&gt;&lt;li&gt;Possesses General PC Windows-based software knowledge with the ability to learn new applications and work in a paperless environment&lt;/li&gt;&lt;li&gt;Good understanding of anatomy and physiology &lt;/li&gt;&lt;li&gt;Good contract knowledge &lt;/li&gt;&lt;li&gt;Familiarity with CPT and ICD10 coding&lt;/li&gt;&lt;li&gt;Possesses good analytical skills and judgment &lt;/li&gt;&lt;li&gt;Ability to be flexible in work schedule, including a willingness to work overtime as needed &lt;/li&gt;&lt;li&gt;Good oral and written communication skills &lt;/li&gt;&lt;li&gt;Ability to handle fast-paced environment &lt;/li&gt;&lt;li&gt;Professional attitude&lt;/li&gt;&lt;li&gt;Dedicated to providing world-class Customer service&lt;/li&gt;&lt;li&gt;Ability to work well within a team environment&lt;/li&gt;&lt;/ul&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;#AFC&lt;/p&gt;

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