Representative, Benefits Adjuster II

American Fidelity•Flowood, MS

11d

About The Position

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 need to be job specific • 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 • Good judgment skills • Organizational skills • Professional attitude • Dedicated to providing world-class Customer service • Ability to work well within a team environment “Compensation range:($45,640.39 - 74,607.20) 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, click here.” ‎ #APL Corporate Careers | Sales Careers | Internships | APL American Fidelity is a certified Great Place to Work for All! No matter where you work in the organization, you have a chance to make a difference. Our culture focuses on helping Colleagues to be their best! We work hard to make a difference to our Customers and community, focus on teamwork and collaboration and always offer a different perspective - a different opinion. We want to meet you! Share your information directly with our American Fidelity recruiting team and join our talent pipeline! American Fidelity specializes in the education, public sector, automotive and healthcare industries with products like group and individual life, health and annuity services as well as other financial security products and services. We’re focused on offering a different opinion to our Customers – making things easier for them by providing benefits administration and education. For our policyholders, we help provide financial security through our benefit offerings, which provide coverage for some of life’s worst events – cancer, accidents, critical illnesses, death and more – and for some of life’s best – childbirth, retirement and more. Learn more about us!

Requirements

3 years need to be job specific
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
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
Good judgment skills
Organizational skills
Professional attitude
Dedicated to providing world-class Customer service
Ability to work well within a team environment

Nice To Haves

Knowledge of insurance claims processes and regulations, preferred
Knowledge of case management tools and ability to apply

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.