Customer-Focused Adjustment Adjudicator Role

Pursue customer satisfaction as an Adjustment Adjudicator dedicated to accurate claim resolutions. This role requires adept handling of adjustments and investigations to meet service expectations.

In this critical position, you'll process daily adjustments and investigations, ensuring quality service standards are upheld. You will own assigned claims, assess both urgency and complexity, and implement efficient strategies for timely resolutions. Effective communication with internal and external clients is essential to enhance customer experience and resolve any discrepancies.

Key Responsibilities:

• Process claims adjustments and stop payments promptly

• Maintain high-quality customer service during all adjustments

• Prioritize claim cases based on urgency and complexity

• Manage written communication with plan members effectively

• Track errors to identify training needs and improve processes

Requirements:

• Experience in claim adjustments or customer service

• Strong communication and problem-solving skills

• Ability to manage multiple tasks efficiently

• Familiarity with SOX compliance is preferred

• Knowledge of Health and Dental claims is advantageous

Drive successful adjustment outcomes with your skills in customer service and claim management.
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