Rep, Benefit Adj I

DESCRIPTION: 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. SLILLS: 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 LI-NR1