Experienced Claims Adjuster

he Loomis Company is seeking individuals who are driven, reliable, and looking to excel with our growing team! For over 65 years, The Loomis Company has been a family owned company committed to protecting what you value mostYour people. Your assets. Your future.

WHO WE ARE:

With a reputation as one of the most trusted insurance experts in the industry, The Loomis Company continually expands our business with a focus on service, expertise, and technology.

WHO WE'RE LOOKING FOR:

Please note: This position requires direct experience adjudicating medical claims. Highly motivated team members that have a drive to learn and grow. This position will entail:

• Examining, processing, calculating and adjudicating claims in compliance to plan documentation
• Processing any open audits daily
• Following daily direction to process high dollar claims and other priorities/issues listed on the daily reports that are distributed twice each day (morning and afternoon)
• Maintaining customer service logs within a 5 day turnaround time
• Maintaining HR logs within a 2 day turnaround time
• Complying with state laws, policy, company procedures, and plan documentation
• Entering codes, and verifying data for computer processing
• Meeting or exceeding daily claim production goals.
• Providing service to claimants, providers, and clients with problems or questions regarding their claims and/or policies via telephone or correspondence.
• Maintaining customer service logs and HR logs as stated above, plus meeting or exceeding customer service quality standards
• Completing special projects as assigned

WHERE YOU'LL BE LOCATED:

In a secure, quiet location with high speed, reliable internet either remotely or in our Wyomissing Office located in Pennsylvania. This role is mostly remote, with the exception of reporting to the office once per month for local employees.

WHAT YOU CAN BRING TO THE TEAM:

• Must have ability to interpret and apply provisions of the manuals, SPDs, medical terminology and insurance claims.
• Excellent verbal and written communication skills.
• Knowledge of Microsoft Office products and CORE claims system.
• Ability to define problems, collect data, establish facts and draw valid conclusions.
• Ability to interpret an extensive variety of instructions.
• Courteous telephone communication skills to provide backup customer service to clientele when needed.

DESIRED EDUCATION AND EXPERIENCE:

High School Diploma or General Education Degree (GED), plus six to twelve months related experience and/or training with medical codes and terminology, or equivalent combination of education and experience. 13 years claims adjusting experience is highly preferred.

WHAT WE HAVE TO OFFER YOU:

• Generous Paid Time Off & paid Holidays
• Work/Life Balance
• Medical, Dental, and Vision
• Healthcare spending or reimbursement accounts such as HSA or FSA
• Employer paid Core Benefits - Life Insurance, Short & Long Term Disability, EAP
• 401k with Company match
• Many Company sponsored employee events
• Career advancement possible

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to perform keyboard work, verbal communications and close vision computer use. The employee may need to lift and/or move up to fifteen (15) pounds

HIPAA SECURITY STATEMENT:

This position may require access to private health information (PHI) and/or electronic private health information (EPHI) for Loomis Company clients. The minimum necessary access will be granted based on the employees responsibilities. To perform their job requirements, certain employees may also be granted access to PHI and EPHI of Loomis Company employees.

The Loomis Company is proud to be an equal opportunity employer committed to hiring a diverse and inclusive workforce. We provide equal employment opportunities to all employees and employment applicants without regard to unlawful considerations of sex, sexual orientation, gender (including gender identity and/or expression), pregnancy, race, color, creed, national or ethnic origin, citizenship status, religion, disability, marital status, age, genetic information, veteran status or any personal attribute or characteristic that is protected by applicable local, state or federal laws.

This employer uses E-Verify. Please visit the following website for additional information: The Loomis Company E-Verify. E-Verify is a program that electronically confirms a candidates eligibility to work in the United States after completing the Employment Eligibility Verification (Form I-9). The information provided on the Form I-9 is compared to the records contained in the Social Security Administration and Department of Homeland Security (DHS) databases. This helps employers verify the identity and employment eligibility of newly hired employees.