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Medical Claims Adjuster
Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO) is a leading technology services and consulting company focused on building innovative solutions that address clients’ most complex digital transformation needs. Leveraging our holistic portfolio of capabilities in consulting, design, engineering, and operations, we help clients realize their boldest ambitions and build future-ready, sustainable businesses. With over 230,000 employees and business partners across 65 countries, we deliver on the promise of helping our customers, colleagues, and communities thrive in an ever-changing world. For additional information, visit us at www.wipro.com.
Job Description
Claims Adjustment Examiner
Location : Remote
Work authorization: US Citizen or US Green Card only
Hours: Mon- Fri 7:30AM -3:30 PM EST or 8:00 AM - 4:30 PM EST
Compensation : $23 per hour
Position Summary: The Claims Adjustment Examiner position is integral to ensuring the accuracy and integrity of medical, dental, and vision claims processing. Your role involves thorough examination and adjustment of claims to align with the outlined plan guidelines, providing a crucial link between our clients and their health benefits. By diligently reviewing each submission, you will play an essential part in upholding the trust that our clients place in us, contributing significantly to their overall experience with our services.
This role demands not only keen analytical skills but also a compassionate approach, as you will often be interacting with clients to clarify and resolve issues related to their claims. As you navigate the complexities of the claims process, you will find yourself immersed in a diverse and dynamic environment that values accuracy, efficiency, and customer satisfaction.
Additional Job Duties:
- Examine and process medical claims in adherence to plan guidelines while ensuring completion within set turnaround times.
- Interpret and apply medical plan guidelines to guarantee proper coding in our systems.
- Assess the legitimacy and correctness of claims to maintain a high standard of accuracy.
- Meet and exceed the production and quality benchmarks established for adjusters, contributing to the overall efficiency of the team.
- Allocate over-payments and refunds appropriately to resolve any existing financial discrepancies.
- Assist in addressing customer service inquiries regarding claims, providing clarity and guidance to enhance the client experience.
- Review additional documentation swiftly to adjust claims accordingly, ensuring that all submissions are processed accurately based on newly provided information. Undertake other responsibilities as delegated to support the overall objectives of the claims department.
Requirements:
- High School Diploma or GED is required.
- Proven problem-solving skills and the ability to interpret benefit plans effectively.
- Familiarity with CPT codes, ICD9/ICD10 coding, and medical terminology is an asset.
- Adept at working independently, demonstrating initiative and self-motivation in daily tasks.
- Proficient in computer operations with the capability to engage with relevant software effortlessly. Possess average typing skills to ensure timely input of data and communication
Preference:
Associate's degree or higher.The expected compensation for this role ranges from $22 to $23/per hour.
Final compensation will depend on various factors, including your geographical location, minimum wage obligations, skills, and relevant experience. Based on the position, the role is also eligible for Wipro’s standard benefits including a full range of medical and dental benefits options, disability insurance, paid time off (inclusive of sick leave), other paid and unpaid leave options.
Applicants are advised that employment in some roles may be conditioned on successful completion of a post-offer drug screening, subject to applicable state law.
Wipro provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. Applications from veterans and people with disabilities are explicitly welcome.
Reinvent your world. We are building a modern Wipro. We are an end-to-end digital transformation partner with the boldest ambitions. To realize them, we need people inspired by reinvention. Of yourself, your career, and your skills. We want to see the constant evolution of our business and our industry. It has always been in our DNA - as the world around us changes, so do we. Join a business powered by purpose and a place that empowers you to design your own reinvention.
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