[Hiring] Benefits Adjuster II @Regis Remote Office

Role Description

We are seeking a detail-oriented and analytical Benefits Adjuster II to evaluate, process, audit, and adjust moderately complex insurance claims for various insurance products, including:

• Accident
• Critical Illness
• Hospital Indemnity
• Health Reimbursement Arrangements (HRA)
• Short-Term Disability
• Medlink claims

The Benefits Adjuster II will be responsible for:

• Reviewing claim documentation
• Interpreting insurance policies
• Determining benefit eligibility
• Ensuring claims are processed accurately and in accordance with company policies, applicable insurance laws, regulatory requirements, and established guidelines

This position also involves:

• Communicating with claimants, medical providers, employers, and other internal and external stakeholders to provide guidance, resolve inquiries, and deliver excellent customer service

Qualifications

• Associate degree required
• Equivalent business experience may be considered in lieu of formal education
• Minimum of 3 years of job-specific experience in insurance claims processing, benefits administration, or a related field
• Previous experience evaluating, processing, auditing, or adjusting insurance claims
• Knowledge of insurance claims procedures, policy interpretation, and applicable regulations is preferred
• Good understanding of medical terminology and human physiology
• Intermediate proficiency in Microsoft Office applications, particularly Excel and Word
• Proficiency with Windows-based computer systems and the ability to learn new software applications
• Experience working with case management systems and electronic documentation
• Ability to work effectively in a paperless environment
• Strong analytical and problem-solving skills
• Excellent verbal and written communication skills
• Strong attention to detail and accuracy
• Good organizational and time-management skills
• Ability to interpret insurance contracts and apply benefit provisions appropriately
• Sound judgment and decision-making abilities
• Ability to manage multiple priorities in a fast-paced environment
• Strong interpersonal skills and a collaborative approach to teamwork
• Professional attitude and commitment to delivering excellent customer service
• Flexibility to work overtime when necessary

Requirements

• Consistently meets or exceeds productivity and workload management expectations
• Maintains high levels of accuracy and quality in claim processing
• Makes fair and accurate decisions on moderately complex claims with limited supervision
• Demonstrates a thorough understanding of departmental procedures, insurance contracts, and benefit provisions
• Effectively communicates claim requirements and decisions to customers
• Consistently delivers excellent customer service and meets established quality standards

Company Description

Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.