What are the responsibilities and job description for the Claims Adjudicator position at Amwins Group, Inc.?
Amwins is the industry leader because we hold ourselves accountable to deliver results – for our employees, our clients, our markets and our shareholders.
We’ve built a workplace where talent is valued and success is celebrated. With a focus on service to our clients as well as our communities, our culture is defined by supporting each other. In this team-driven environment, Amwins creates the perfect place for you to grow your career with built-in support and opportunity to advance your knowledge base.
At Amwins our people are our greatest asset. We hire the best talent in the industry and provide our employees with the tools to deliver innovative insurance solutions. We believe that by taking care of our employees they will take care of our clients and the cycle will perpetuate.
Learn more about us at amwins.com.
RESPONSIBILITIES:
- Read, review, and analyze claims for complete information.
- Conduct a thorough investigation of disclosure information and preexisting conditions.
- Verify benefit eligibility/membership and coverage type.
- Determine appropriate copay, coinsurance, and deductible information according to plan documents.
- Adjudicate claims appropriately using departmental procedures and guidelines as applicable.
- Send appropriate correspondence to providers/members requesting additional information as needed.
- Meet or exceed productivity and quality requirements.
- All other duties as assigned.
This list is not intended to be an all-inclusive representation of the responsibilities of this position but instead is intended to present a summary of its major functions. Specific assignments may be changed at the discretion of Management.
EXPERIENCE REQUIREMENTS:
- Excellent written and verbal communication skills.
- Excellent analytical skills.
- Extensive knowledge and experience in investigating claims for validity and compensability.
- Ability to identify and investigate insurance disclosures and preexisting conditions.
- Interpersonal skills.
- Excellent organizational skills.
- Ability to work independently.
- Previous experience with Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9/ICD-10) coding structures.
- Thorough knowledge of Preferred Provider Organization (PPO) structures.
- Successful completion of course in medical terminology.
- Minimum of two years prior experience processing medical insurance claims.
Snapshot of what Amwins provides to our team members:
- Compensation includes a salary commensurate with experience
- Some position eligible for overtime
- Position eligible for annual bonus
- Full benefits package available, benefits start first day of employment
- Generous Paid Time Off (PTO)
- Collaborative, continuing education focused work environment
- Career advancement opportunities
- Opportunity for formal sales and leadership training
The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or physical requirements. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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