What are the responsibilities and job description for the Benefits Adjuster IV position at American Fidelity?
- Evaluates, process, manages and/or audits claims that require complex to advanced judgement and investigation and a high degree of analysis such as highly complex medical and life claims, contestable claims and problematic claims in accordance with Company policy terms, insurance laws, regulatory requirements, and adjusting/claim management guidelines and provides training to lower level adjusters.
- Provides appropriate verbal and/or written communication to internal and external Customers in a positive and knowledgeable manner to ensure a high standard of Customer service. Meets standards established in department performance metrics for appropriate handling of Customer calls.
- Acts as a direct contact and communicate with internal and external Customers and medical providers in a positive, knowledgeable and professional manner, providing them with direction and assistance in all facets of insurance coverage and needs.
- High school diploma or general education degree (GED)
- Prompt and reliable
- Advanced knowledge of medical terminology
- Proficient with PC Windows-based software, including Microsoft Office
- Easily adapts to new software/technology applications and is able to excel in a paperless environment
- Advanced knowledge of anatomy and physiology (not applicable to life processing only)
- Advanced contract knowledge
- Advanced familiarity with CPT and ICD-10 coding (not applicable to life processing only
- Possesses high degree of decision making ability
- Strong research and analytical skills
- Flexible work schedule, including willingness to work overtime as needed
- Strong communication skills, both verbal and written
- Ability to handle fast-paced environment
- Professional attitude
- Dedicated to providing world-class Customer service
- Exceptional medical or lifeclaim management knowledge
- Ability to work well in a team environment
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