Claims Adjuster

This is a fully remote position, open to applicants in Wisconsin.

📋 Description

• Conduct thorough investigations, evaluations, and resolutions of travel medical claims from start to finish.

• Adjudicate benefits in accordance with policy stipulations and regulatory requirements.

• Manage invoice processing through cost-containment systems.

• Provide clear and timely updates to customers, providers, and partners regarding claim statuses.

• Ensure thorough documentation within the claims system, maintaining complete and high-quality files.

• Evaluate the need for medical management and escalate cases as necessary.

• Process bills in compliance with statutory regulations and internal controls.

• Detect potential fraud, waste, or abuse and work collaboratively with the investigative team.

• Exhibit exceptional written and verbal communication with customers throughout the claims process.

• Take on additional responsibilities as required to support the team and our clients.

⛳️ Requirements

• Demonstrated experience in managing accident and sickness/travel medical claims, including intricate domestic and international cases.

• Possession of current (or the ability to acquire) state adjuster licensing.

• A strong belief that claims processing should improve, rather than obstruct, the customer experience.

• Proficiency in writing, negotiation, communication, organization, reporting, data collection, reserving, brainstorming, and research.

• Comfort with data analysis, forms, spreadsheets, and understanding policy language.

🏝️ Benefits

• Health insurance

• 401(k) matching

• Flexible work hours

• Paid time off

• Remote work options