JOB DESCRIPTION:

The Claims Adjudicator is responsible for accurate and timely adjudication of Wellness and Other claims.  This may include additional investigation to obtain necessary information (order medical records etc.) to complete the claim review and processing. Duties and responsibilities also include the following:

Core Competencies:  
•    Attention to detail
•    Proven organizational ability
•    Reliability
•    Ability to work independently
 

Communication Skills
•    Conveys information clearly and effectively both written and oral
•    Remains focused on improving communication skills while continuously enhancing knowledge on client products and services
•    Possesses strong interpersonal skills 

Problem Solving
•    Understands the applicable aspects of the client products/services needed to perform their task
•    Ability to accurately and quickly perform mathematical calculations
•    Concentrates on fostering processing efficiencies while meeting quality standards
•    Displays exemplary analysis and problem-solving capabilities 

Teamwork
•    Works well with others
•    Develops rapport and trust
•    Participates actively in team discussions and activities
•    May assist less experienced or temporary staff when appropriate

Client Focus
•    Focuses on achieving client and company goals
•    Flexible and trainable
•    Aims to maintain excellent relations with the client, client customers (providers), team and internal
•    Strives to maintain a sound knowledge of the support
•    Maintains customer focus and service orientation

Security Compliance

•    Employees are required to maintain compliance with company safety, security and privacy programs (secrecy of all information and project-related information that may be acquired about the business, its affiliates and partners).

PROCESSES
•     Claims Processing/Adjudication that will require additional analysis and investigation