• Claims Adjuster - Texas Non-Subscription

    Baylor Scott & White Health (Dallas, TX)


    JOB SUMMARY

    Under the direct supervision of the Safe Choice Claims Manager the Claims Adjuster is responsible for the review, analysis and processing of assigned claims within their authority limits and consistent with policy and legal requirements. The goal of the position is to provide prompt, efficient delivery of quality service while protecting the assets of the organization.

     

    The Claims Adjuster's primary duty includes the exercise of discretion and independent judgment with respect to matters of significant financial impact and confidentiality.

     

    + **HYBRID** position - 2 days onsite each week - Dallas, TX **ESSENTIAL FUNCTIONS OF THE ROLE** Promptly investigate assigned non-subscription claims to assess liability and entitlement to benefits.Confirm applicable coverage; maintain compliance w/ERISA plan document, insurance policies and procedure manuals. Take recorded statements, establish reserve requirements, identify subrogation potential, maintain diaryReview and evaluate medical and loss wages, conduct thorough investigation of the claim through contact with witnesses. Provide status reports to management as needed. Resolve complex, severe exposure claims, using high service oriented file handling Responsibility for the preparation of summaries and files for denials, appeals, medical opinions, subrogation and litigation.1. Collection of documents and summarizing information.2. Providing presentations for committee meetings and any required correspondence.3. Applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio 4. Assign surveillance on appropriate claims5. Identifying claims with possible recovery from third parties Maintains communication with doctors, attorneys, safety specialist, and nurse specialist and outside vendors to provide prompt, economical and professional handling of all claims.1. Talking to others to convey information effectively2. Communicating effectively in writing as appropriate3. Provide and Coordinate training with HR team4. Work with Claims Manager for improvements in processes to increase proficiency and supervise effective resolution of all claim inquiries.Responsible for the approval of lost wages for payroll and for all approvals of medical bills per claim file.Pay and process claims within designated authority levelPerforms other position appropriate duties as required in a competent, professional and courteous manner. **KEY SUCCESS FACTORS** Can substitute Bachelors degree for years of experienceTexas All Lines Adjuster License, Non-subscription Experience Preferred" **BENEFITS** Our competitive benefits package includes the following- Immediate eligibility for health and welfare benefits- 401(k) savings plan with dollar-for-dollar match up to 5%- Tuition Reimbursement- PTO accrual beginning Day 1Note: Benefits may vary based upon position type and/or level

    QUALIFICATIONS

    - EDUCATION - H.S. Diploma/GED Equivalent

    - EXPERIENCE - 5 Years of Experience

    As a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviours that we promote to our patients. As of January 1, 2012, Baylor Scott & White Health no longer hires individuals who use nicotine products. We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.