Utah Retirement Systems

  • Medical Claims Adjuster

    Location US-UT-Salt Lake City
    Posted Date 6 days ago(8/9/2018 4:49 PM)
    Job ID
    2018-2599
    Category
    Claims Processing
    Minimum Starting Wage
    USD $14.10/Hr.
  • About The Company

    A division of Utah Retirement Systems, PEHP is a non-profit trust with the vital job of providing health benefits to Utah’s public employees and their families.

    Job Description

    Summary:

    Performs a variety of complex clerical duties to expedite the day to day processing and adjudication of medical and Medicare Supplement claims.

     

    Duties and Responsibilities:

    1. Receives and enters medical and/or Medicare claims for payment under medical and/or Medicare Supplement plans.
    2. Reviews claims for accuracy and completeness, verifies coverage and eligibility of patient.
    3. Adjudicates routine and complex claims according to established policy guidelines.
    4. Maintains strict confidentiality.
    5. Performs other related duties as required.

    Required Experience

    Education and Experience

    High School diploma and one (1) year of progressively responsible experience performing a variety of complex clerical duties to expedite the day to day processing and adjudication of medical and Medicare Supplement claims.

     

    Specific experience in claims processing, and various administrative functions is preferred; or an equivalent combination of education and experience.

     

    Knowledge, Skills, and Abilities

    Requires considerable knowledge of medical claims adjudication policies, procedures and processes; intricacies related to medical, mental health and chiropractic claims; medical terminology; various office management systems related to alpha and numeric record keeping; interpersonal communication skills; telephone etiquette; personal computer operations (PC/MS DOS) and various  program applications; basic bookkeeping; negotiation techniques; some knowledge of 10 key operation; basic mathematics; basic public relations.

     

    Must have the ability to analyze a variety of routine claims management issues and problems and make routine corrections; communicate effectively verbally and in writing; ability to follow verbal instructions; establish and maintain effective working relationships with professionals, executives (public and private) department heads, co workers and the public; work independently and deal effectively with stress caused by work load and time deadlines.

     

    Work Environment

    Incumbent performs in a typical office setting with appropriate climate controls. Tasks require a variety of physical activities which do not generally involve muscular strain, but do require activities related to walking, standing, stooping, sitting, reaching, talking, hearing and seeing.  Common eye, hand, finger dexterity required to perform essential functions. 

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