Modify Search

  • This field is required.

  • This field is required.

  • This field is required.

Jobs In North Dakota

Immediate Position For Claim Adjudicator @Westrac, Fargo, ND || Full time 246
Yochana IT Solution Inc
Fargo, ND, USA

Job description and Work Activities involved

  • Review insurance policies to determine VALID coverage
  • Reviews, evaluates 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)
  • Evaluate customer records (Medical information, Demographics, Wages)
  • Examine evidence to determine if it will support charges
  • Scrutinize insurance claims
  • Make decisions ( Pay or Reject the claim)
  • Obtain additional information from individuals/parties
  • Responsible for maintaining high level 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 supervisor
  • Doing necessary follow - ups on a daily basis
  • Ensuring there are no pending jobs left in their individual queues at the day end


Functional Competencies and skill sets required for the position

  • Good Communication skills, command over written business correspondence
  • Typing Speed of 30 WPM with 90% accuracy
  • Knowledge of Health Insurance or Insurance industry
  • Aptitude/Analytical Score of 70% & above
  • Familiar with standard concepts, practices, and procedures in Insurance domain.
  • Relies on experience and judgment to plan and accomplish set goals
  • Work under minimal supervision.
  • Typically reports to a supervisor/manager
  • A certain degree of creativity and latitude is expected.
  • 0-2 years of experience in insurance field.

Advanced Search