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Claims Adjuster/ Claim Adjudicator

Aptiva Corp
Fargo, North Dakota, United States
November 09, 2016

Job description and Work Activities involved

Review insurance policies to determine VALID coverage

Reviews, evaluates and processes disability insurance claims according to procedure and practice

Calculate Benefit rate for concurrent employers (Benefits to be paid)

Determine liability ( Whether employee or Employer is eligible)

Evaluate customer records (Medical information, Demographics, Wages)

Examine evidence to determine if it will support charges

Scrutinize insurance claims

Make decisions ( Pay or Reject the claim)

Obtain additional information from individuals/parties

Responsible for maintaining high level of accuracy as per SLA

Processing of Claims as per the tasks allocated

Responsible for processing all the assigned tasks within the stipulated timeline

Responsible for maintaining turnaround time and accuracy as per SLA

Updating Procedures as and when required

Updating and escalating any new/complex scenarios to the supervisor

Doing necessary follow - ups on a daily basis

Ensuring there are no pending jobs left in their individual queues at the day end

Educational Qualification required for the position.



*Perusing education or result awaited also eligible

Functional Competencies and skill sets required for the position

Good Communication skills, command over written business correspondence

Typing Speed of 30 WPM with 90% accuracy

Knowledge of Health Insurance or Insurance industry

Aptitude/Analytical Score of 70% & above

Familiar with standard concepts, practices, and procedures in Insurance domain.

Relies on experience and judgment to plan and accomplish set goals

Work under minimal supervision.

Typically reports to a supervisor/manager

A certain degree of creativity and latitude is expected.

0-2 years of experience in insurance field

Relevant experience required for the position

Claim Adjuster

Candidates with 0 to 1 year of experience