Claims Adjudicator (Medical & Dental)

POSITION OVERVIEW:
Working under the direction of the Claims Manager is responsible to provide timely and accurate adjudication and reimbursement of medical and dental claims submitted by members covered under our clients' Benefit Trust Funds and to provide courteous and professional customer service while maintaining departmental standards.
DUTIES AND RESPONSIBILITIES:
Analyze, process, research, adjust and adjudicate claims according to contract provisions with the provider agreement.
Evaluate medical and dental claims within service standards established by the company.
Apply guidelines, determine coverage, complete eligibility verification, and identify discrepancies.
Correspond and communicate with members via telephone, written correspondence or face-to-face.
Provide excellent customer service to internal and external clients.
QUALIFICATIONS:
1. Analytical skills to research review and assess claims.
2. 1-2 years experience in dental and medical claims adjudication or comparable experience with a third party provider or with group benefits.
3. Accuracy and attention to detail with exceptional organizational skills.
4. Strong verbal and written communication skills. Bilingual (English and either Portuguese or Italian) written and verbal communication skills an asset.
5. Ability to learn multiple benefit packages.
6. Intermediate computer skills in the use of related computer applications: data entry and tracking program data and preparing correspondence, (including Microsoft Word, Excel and Outlook).Please send cover letter and resume: to resume@bpagroup.com
Apply Via Emailresume@bpagroup.com