UNITE HERE HEALTH ยท 10 hours ago
Claims Adjudicator II
Oak Brook, IL
Full-time
Hybrid
Mid Level
$20.36/hr - $24.97/hr
3+ years expUNITE HERE HEALTH serves 190,000+ workers and their families in the hospitality and gaming industry nationwide. The Claims Adjudicator II position is responsible for receiving, examining, verifying, and inputting submitted claim data, determining eligibility status, and reviewing and adjudicating claims within established timeframes.
ConsultingHealth CareHospitalNon Profit
Hiring Manager
Lori Yunk
Responsibilities
Screens claims for completeness of necessary information
Verifies participant/dependent eligibility
Interprets the plan benefits from the Summary Plan Description (SPD)/Plan Documents
Codes basic information and selects codes to determine payment liability amount
Evaluates diagnoses, procedures, services, and other submitted data to determine the need for further investigation in relation to benefit requirements, accuracy of the claim filed, and the appropriateness or frequency of care rendered
Determines the need for additional information or documentation from participants, employers, providers and other insurance carriers
Handles the end to end process of Medicare Secondary Payer (MSP) files
Processes Personal Injury Protection (PIP) claims
Requests overpayment refunds, maintains corresponding files and performs follow-up actions
Handles verbal and written inquiries received from internal and external customers
Processes Short Term Disability claims
Adjudicates claims according to established productivity and quality goals
Achieve individual established goals in order to meet or exceed departmental metrics
Qualification
Required
3 ~ 5 years of direct experience minimum in a medical claim adjudication environment
Working knowledge and experience in interpretation of benefit plans, including an understanding of limitations, exclusions, and schedule of benefits
Experience with eligibility verification, medical coding, coordination of benefits, and subrogation and it's related processes
Experience with medical terminology, ICD10 and Current Procedural Technology (CPT) codes
Preferred
Fluency (speak and write) in Spanish
Benefits
Medical
Dental
Vision
Paid Time-Off (PTO)
Paid Holidays
401(k)
Pension
Short- & Long-term Disability
Life
AD&D
Flexible Spending Accounts (healthcare & dependent care)
Commuter Transit
Tuition Assistance
Employee Assistance Program (EAP)
Company
UNITE HERE HEALTH
Unite Here Health is a non-profit organization that provides health benefits and healthcare services.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Angela Riley, MD
CEO Hospitality Rx
Matthew Walker
CEO
Company data provided by crunchbase