Claims Sps-Encounter

CA - Palmdale,

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Claim Adjudicator/ Claim Adjudicator opportunity in Palmdale,CA for a growing Health Insurance Company
Job type- Full time
Technical/ Functional/ Must have skills-
-Review insurance policies to determine VALID coverage
-Reviews, evaluates and processes disability insurance claims according to procedure and practice
-Calculate Benefit rate for concurrent employers (Benefits to be paid)
-Determine liability ( Whether employee or Employer is eligible)
-Evaluate customer records (Medical information, Demographics, Wages)
-Examine evidence to determine if it will support charges
-Scrutinize insurance claims
-Make decisions ( Pay or Reject the claim)
-Obtain additional information from individuals/parties
-Responsible for maintaining high level of accuracy as per SLA
-Processing of Claims as per the tasks allocated
-Responsible for processing all the assigned tasks within the stipulated timeline
-Responsible for maintaining turnaround time and accuracy as per SLA
-Updating Procedures as and when required
-Updating and escalating any new/complex scenarios to the supervisor
-Doing necessary follow - ups on a daily basis
-Ensuring there are no pending jobs left in their individual queues at the day end

Functional Competencies and skill sets required for the position
- Good Communication skills, command over written business correspondence
- Typing Speed of 40 WPM with 90% accuracy
- Knowledge of Health Insurance or Insurance industry
- Familiar with standard concepts, practices, and procedures in Insurance domain.
- Relies on experience and judgment to plan and accomplish set goals
- Work under minimal supervision.
- Typically reports to a supervisor/manager
- A certain degree of creativity and latitude is expected.
- 0-2 years of experience in insurance field
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