Benefit Adjuster III - Leave Services
Open to local OKC candidates or fully remote
Evaluates, processes, manages and/or audits claims that require complex judgement and investigation such as , Cancer claims, Leave Absence Management Claims, Short Term Disability claims requiring claim management, Permanent and Total Disability claims or claims requiring Pre-Existing investigation, or life claims and claims on other life-related products and associated riders, and Stop Loss claims in accordance with Company policy terms, insurance laws, regulatory requirements, department standards 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 internal and external 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.
Requirements: Minimum 3 years claims processing experience
FMLA/PFML experience required
Prompt and reliable
Advanced knowledge of medical terminology
Proficient with PC Windows-based software, including Microsoft Office
Easily adapts to new software/technology applications and is able to excel in a paperless environment
Advanced contract knowledge
Advanced familiarity with CPT and ICD-10 coding
Possesses a high degree of decision-making ability
Strong research and analytical skills
Flexible work schedule, including willingness to work overtime as needed
Strong communication skills, both verbal and written
Ability to handle fast-paced environment
Professional attitude
Dedicated to providing world-class customer service
Ability to work in a team environment
- Compensation range: $24.17/hour to $35.87/hour, plus may be eligible for an annual discretionary company bonus. Actual compensation within that range will be dependent upon the individual's skills, experience/qualifications and geographic zone. For more information on our organization and company benefits please visit our career site at http://americanfidelity.com/careers/.
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