Claims - Adjuster, Claims I

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.

Location: Baltimore, MD

Description:

Required Skills:

• Medical Claims processing experience.
• Medical Claims Adjustment experience.
• Medical Terminology, Provider Refund.
• Subrogation, Workers Comp.
• Disbursements.

Purpose:

Investigate and perform adjustment of claims and ensure that claims are handled properly within authority limits, and in line with standard procedures and guidelines. Verifies insurance claims by reviewing claims requirements; examining documentation and calculations; highlighting and summarizing out-of-line situations; recommending changes in operating processes; completing reports, logs, and audit records.

Essential Functions:

• 60% Proactively investigate and perform adjustments of claims. Ensure claims are handled within authority limits, and in line with standard procedures and guidelines.
• 20% Updates claims audit records by entering, verifying, and securing data.
• 10% Settle standard/complex claims through payment or denial.
• 5% Provides claims audit information and reports by collecting, analyzing, and summarizing data and trends.
• 5% Improves claims adjustment job knowledge by attending training sessions.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level: High School Diploma or GED

Experience: 3 years of claims experience and complete understanding of all systems, policies, and procedures.

Preferred Qualifications:

Knowledge, Skills, and Abilities (KSAs):

• Ability to analyze information gathered from investigation, Proficient
• Excellent communication skills both written and verbal, Proficient
• Ability to recognize, analyze, and solve a variety of problems, Proficient
• Skill in completing assignments accurately with attention to detail, Proficient.

Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans, or individuals with disabilities.