Job Description :
Claim Adjudicator Full time Westrac, Fargo, ND Job description: Reiew insurance policies to determine ALID coerage Reiews, ealuates 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) Ealuate customer records (Medical information, Demographics, Wages) Examine eidence to determine if it will support charges Scrutinize insurance claims Make decisions ( Pay or Reject the claim) Obtain additional information from indiiduals/parties Responsible for maintaining high leel 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 superisor Doing necessary follow - ups on a daily basis Ensuring there are no pending jobs left in their indiidual queues at the day end Functional Competencies and skill sets required for the position: Good Communication skills, command oer written business correspondence Typing Speed of 30 WPM with 90% accuracy Knowledge of Health Insurance or Insurance industry Aptitude/Analytical Score of 70% & aboe Familiar with standard concepts, practices, and procedures in Insurance domain. Relies on experience and judgment to plan and accomplish set goals Work under minimal superision. Typically reports to a superisor/manager A certain degree of creatiity and latitude is expected. 0-2 years of experience in insurance field.