Claims Adjuster, Claims I

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.

Location: Baltimore MD

Description:

Required Skills:

• Medical Claims processing experience.
• Medical Claims Adjustment experience.
• Medical Terminology Provider Refund.
• Subrogation Workers Comp.
• Disbursements.

Purpose:

Investigate and perform adjustment of claims and ensure that claims are handled properly within authority limits and in line with standard procedures and guidelines. Verifies insurance claims by reviewing claims requirements; examining documentation and calculations; highlighting and summarizing out-of-line situations; recommending changes in operating processes; completing reports logs and audit records.

Essential Functions:

• 60% Proactively investigate and perform adjustments of claims. Ensure claims are handled within authority limits and in line with standard procedures and guidelines.
• 20% Updates claims audit records by entering verifying and securing data.
• 10% Settle standard/complex claims through payment or denial.
• 5% Provides claims audit information and reports by collecting analyzing and summarizing data and trends.
• 5% Improves claims adjustment job knowledge by attending training sessions.

Qualifications:

To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level: High School Diploma or GED

Experience: 3 years of claims experience and complete understanding of all systems policies and procedures.

Preferred Qualifications:

Knowledge Skills and Abilities (KSAs):

• Ability to analyze information gathered from investigation Proficient
• Excellent communication skills both written and verbal Proficient
• Ability to recognize analyze and solve a variety of problems Proficient
• Skill in completing assignments accurately with attention to detail Proficient.

Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin age protected veterans or individuals with disabilities.