Experienced Claims Adjuster

About the position

The Loomis Company is seeking an experienced Claims Adjuster to join their team. This full-time position involves examining, processing, and adjudicating medical claims while ensuring compliance with relevant laws and company policies. The role is primarily remote, with occasional office visits, and requires strong communication skills and the ability to work efficiently in a fast-paced environment.

Responsibilities

• Examine, process, calculate, and adjudicate claims in compliance with plan documentation.
• Process any open audits daily.
• Follow daily direction to process high dollar claims and other priorities/issues listed on daily reports.
• Maintain customer service logs within a 5-day turnaround time.
• Maintain HR logs within a 2-day turnaround time.
• Comply with state laws, policy, company procedures, and plan documentation.
• Enter codes and verify data for computer processing.
• Meet or exceed daily claim production goals.
• Provide service to claimants, providers, and clients regarding their claims and/or policies via telephone or correspondence.
• Complete special projects as assigned.

Requirements

• High School Diploma or GED.
• 6 to 12 months related experience and/or training with medical codes and terminology, or equivalent combination of education and experience.
• 1 to 3 years claims adjusting experience is highly preferred.
• Ability to interpret and apply provisions of manuals, SPDs, medical terminology, and insurance claims.
• Excellent verbal and written communication skills.
• Knowledge of Microsoft Office products and AS400 claims system.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Courteous telephone communication skills.

Nice-to-haves

• Experience with HIPAA regulations.
• Familiarity with insurance claims processing software.

Benefits

• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Generous Paid Time Off & paid Holidays
• Work/Life Balance
• Employer paid Core Benefits - Life Insurance, Short & Long Term Disability
• Career advancement possible