APL Adjuster II

Responsibilities

• Evaluates, processes and/or audits claims that require moderate to complex judgement and investigation such as Accident, Critical Illness, Hospital Indemnity, HRA, New Short Term Disability or Medlink claims in accordance with Company policy terms, insurance laws, regulatory requirements and adjusting guidelines.
• 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 phone calls.
• Acts as a direct contact and communicates 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.

• 3 years of job-specific experience.
• Prompt and reliable.
• Good understanding of medical terminology and physiology.
• Possesses PC Windows-based software knowledge, including intermediate proficiency in Microsoft Office applications, with the ability to train on new applications and work in a paperless environment.
• Knowledge of insurance claims processes and regulations, preferred.
• Knowledge of case management tools and ability to apply.
• Good analytical skills.
• Good communication skills, both verbal and written.
• Good interpersonal skills (team orientation).
• Ability to multi‑task in a fast‑paced environment.
• Ability to be flexible in work schedule, including a willingness to work overtime as needed.
• Organizational skills.
• Professional attitude.
• Dedicated to providing world‑class customer service.
• Ability to work well within a team environment.

Compensation range: $45,640. plus may be eligible for an annual discretionary company bonus. Actual compensation within that range will be dependent upon the individual's skills, experience, qualifications, and geographic location. For a general description of all employment benefits, .