What are the responsibilities and job description for the Health Claims Adjuster position at Medical Mutual of Ohio?
Health Claims Adjuster
- (2300027)
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies headquartered in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
Job Summary:
The Health Claims Adjuster Reviews and evaluates paper and electronic claims for benefits in accordance with policy provisions. Hybrid position based in our Oklahoma City, OK office.
Essential Functions:
- Evaluate claim material to determine eligibility
- Ensure policy benefits are paid accurately, if applicable
- Apply benefits on every applicable policy
- Request additional information when required
- Apply appropriate denial codes if no benefits are payable
- Work independently
- Interface with outside vendors or other departments within the or
- Assist with special projects
- Provide Subject matter expertise in some areas
Position Qualifications:
- High school diploma or equivalent
- Typically has 2 plus years’ experience with health insurance claims
- Knowledge and understanding of ICD-10, CPT, and HCPCS codes
- Understanding of HIPPA guideline
- Understands basic medical terminology
- Proficient in basic computer skills. MS Outlook, Excel, PowerPoint, and Word
- Excellent verbal and written communication skills
- Good organizational and time management skills
We truly value and respect the talents and abilities of all our employees. That's why we offer an exceptional package that includes:
Excellent Benefits
- 401(k) with company match up to 4% and an additional company contribution.
- Health Savings Account with a company matching contribution.
- Excellent medical, dental, vision, life, and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
- Parental leave for eligible employees who become parents through maternity, paternity, or adoption.
An Investment in You
- Career development programs and classes.
- Mentoring and coaching to help you advance in your career.
- Tuition reimbursement up to $5,250 per year, the IRS maximum.
At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.