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Title: Claim Adjuster

Requisition ID: 83662

City: Tampa

Country/Region: US

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

The Claims Adjustment Examiner position is integral to ensuring the accuracy and integrity of medical, dental, and vision claims processing within Healthplan Services Inc. Your role involves the 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.

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ESSENTIAL JOB FUNCTIONS/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.

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QUALIFICATION REQUIREMENTS:

High School Diploma or GED is required, with a preference for candidates holding an Associate's degree or higher.
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.

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EDUCATION REQUIREMENTS:

Completion of a High School Diploma is mandatory; candidates with an Associate degree are encouraged to apply.

COMPETENCIES:

Client Centricity: Ability to prioritize client needs and provide tailored support.
Passion for Results: Focused on achieving high-quality outcomes in a timely manner.
Execution Excellence: Commitment to delivering consistent and superior service.
Collaborative Working: Ability to work effectively within a team to achieve common goals.
Learning Agility: Openness to acquiring new skills and adapting to changing environments.
Problem Solving & Decision Making: Skilled at analyzing issues and making informed decisions.
Effective Communication: Strong verbal and written communication skills essential for client interactions.

“This role will onsite, you must live within a 60-minute commute of Wipro/Client’s office location in [Tampa] to facilitate training, corporate services and other in-person requirements of the role.”

Expected pay for this role ranges from $23/hr to $25/hr. 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 option

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. Come to Wipro. Realize your ambitions.

Applications from people with disabilities are explicitly welcome.

If you encounter any suspicious mail, advertisements, or persons who offer jobs at Wipro, please email us at helpdesk.recruitment@wipro.com. Do not email your resume to this ID as it is not monitored for resumes and career applications.

Any complaints or concerns regarding unethical/unfair hiring practices should be directed to our Ombuds Group at ombuds.person@wipro.com.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, caste, creed, religion, gender, marital status, age, ethnic and national origin, gender identity, gender expression, sexual orientation, political orientation, disability status, protected veteran status, or any other characteristic protected by law.

Wipro is committed to creating an accessible, supportive, and inclusive workplace. Reasonable accommodation will be provided to all applicants including persons with disabilities, throughout the recruitment and selection process. Accommodations must be communicated in advance of the application, where possible, and will be reviewed on an individual basis. Wipro provides equal opportunities to all and values diversity.

Nearest Major Market: Tampa

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