Adjustment Clerk jobs in Saint Louis, MO

Adjustment Clerk reviews and follows up on customer complaints regarding account balances and uncredited items. Analyzes associated documents and makes necessary adjustments to accounts and/or recommendations to resolve customer issues. Being an Adjustment Clerk communicates results of findings to customer. Requires a high school diploma or its equivalent. Additionally, Adjustment Clerk typically reports to a supervisor or manager. The Adjustment Clerk possesses a moderate understanding of general aspects of the job. Works under the close direction of senior personnel in the functional area. May require 0-1 year of general work experience. (Copyright 2024 Salary.com)

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Claims Adjustment Clerk
  • Delta Dental of Missouri
  • St. Louis, MO FULL_TIME
  • Delta Dental of Missouri is seeking a Claims Adjustment Clerk in St. Louis, Missouri. The Claims Adjustment Clerk is responsible for timely and accurate processing of dental claims.

    Responsibilities

    • Process claims submitted for payment. Either manually enter claims information via PC or review previously entered data for accuracy and completeness. Investigate and release all claims including those that suspend for system edits. Make additional claim payments when necessary. Submit refund requests if overpayment is discovered.

    • Process claims submitted for predetermination. Manually enter claims information via PC or review previously entered data for accuracy and completeness. Investigate and release all claims including those that suspend for system audits.

    • Review x-rays and make benefit determination or refer claim to consultant for decision.

    • Research and respond to escalated claims inquiries from Customer Service, Account Management and Group Accounts.

    • Prepare information request letters and/or contact dental offices via phone for information as needed.

    • Position may be assigned to override system pricing logic for certain groups and certain edits by utilizing the National Provider File and/or HIAA fee data and manually determine benefit payment amounts.

    • Position may be required to access electronic attachment files via internet sites of various vendors.

    • Position may be assigned to process claims received from foreign countries. This includes converting currency to US dollars and at times sending claims to outside translator.

    • Perform similar job-related special projects as assigned.

    • Identify and troubleshoot claims issues within system and report appropriately.

    • Meet and/or exceed daily and monthly claims processing metrics in order to ensure we are meeting our group guarantees.

    Education, Skills, Personal Attributes, and Experience Required

    • High School Diploma or equivalent.

    • Knowledge of dental terminology and/or insurance industry experience preferred.

    • Must have thorough knowledge of various transactions and policies utilized in claims administration functions.

    • Must have complete understanding of claims processing system functions, screens, and methods to resolve edit.

    • Ability to operate a calculator and PC keyboard.

    • Effective communication skills, both written and verbal, are required due to frequent communication with the public and internal customers.

    • Ability to work independently in a remote setting.

    • Ability to understand and keep up to date on DDPA/DDMO/DDSC claims processing policies and desktop business practices.

    • Ability to be a team player.

    • Position requires dependable attendance.

    • Proven subscription to the company's core values of integrity, trust and respect, innovation, stewardship, excellence, and celebration.

    Work Conditions

    • General office working conditions which may require sitting for extended periods of time.

    Physical Requirements

    The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    Specific vision abilities require the ability to focus distant and near objects clearly. While performing the duties of this job, the employee is regularly required to sit, talk and hear. The employee is frequently required to use hands and arms to handle, feel and reach as well as operate a personal computer.


  • 5 Days Ago

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Nurse Practitioner NP, Part-Time, HRA
  • Hueman Risk Adjustment Solutions
  • Madison, IL PART_TIME
  • Hueman is hiring Nurse Practitioners to complete Health Risk Assessments (HRAs) in the homes of Medicare and Medicaid members in Madison, IL. This position offers certified Nurse Practitioners the opp...
  • 22 Days Ago

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Nurse Practitioner NP, Part-Time, HRA
  • Hueman Risk Adjustment Staffing
  • Hills, MO PART_TIME
  • Hueman is hiring Nurse Practitioners to complete Health Risk Assessments (HRAs) in the home of Medicare and Medicaid members in and around Park Hills, MO. This position offers certified Nurse Practiti...
  • 1 Day Ago

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Nurse Practitioner NP, Part-Time, HRA
  • Hueman Risk Adjustment Staffing
  • Kennett, MO PART_TIME
  • Hueman is hiring Nurse Practitioners to complete Health Risk Assessments (HRAs) in the home of Medicare and Medicaid members in and around Kennett, MO. This position offers certified Nurse Practitione...
  • 2 Days Ago

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Nurse Practitioner NP, Part-Time, HRA
  • Hueman Risk Adjustment Staffing
  • Sikeston, MO PART_TIME
  • Hueman is hiring Nurse Practitioners to complete Health Risk Assessments (HRAs) in the home of Medicare and Medicaid members in and around Sikeston, MO. This position offers certified Nurse Practition...
  • 9 Days Ago

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Nurse Practitioner NP, Part-Time, HRA
  • Hueman Risk Adjustment Staffing
  • Troy, MO PART_TIME
  • Hueman is hiring Nurse Practitioners to complete Health Risk Assessments (HRAs) in the home of Medicare and Medicaid members in and around Troy, MO. This position offers certified Nurse Practitioners ...
  • 9 Days Ago

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0 Adjustment Clerk jobs found in Saint Louis, MO area

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Independent Insurance Claims Adjuster in Collinsville, Illinois
  • MileHigh Adjusters Houston Inc
  • Collinsville, IL
  • Exciting Opportunity for Aspiring Claims Adjusters! INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to ...
  • 3/28/2024 12:00:00 AM

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Independent Insurance Claims Adjuster in Belleville, Illinois
  • MileHigh Adjusters Houston Inc
  • Belleville, IL
  • Exciting Opportunity for Aspiring Claims Adjusters! INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to ...
  • 3/28/2024 12:00:00 AM

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Independent Insurance Claims Adjuster in Alton, Illinois
  • MileHigh Adjusters Houston Inc
  • Alton, IL
  • Exciting Opportunity for Aspiring Claims Adjusters! INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to ...
  • 3/28/2024 12:00:00 AM

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Independent Insurance Claims Adjuster in Edwardsville, Illinois
  • MileHigh Adjusters Houston Inc
  • Edwardsville, IL
  • Exciting Opportunity for Aspiring Claims Adjusters! INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to ...
  • 3/28/2024 12:00:00 AM

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Independent Claims Adjusters Needed NOW for the Storm Season
  • Mocat
  • Saint Louis, MO
  • Independent Adjusters Needed Are you Interested in becoming an Independent Claims Adjuster? The 2021 storm season was an...
  • 3/28/2024 12:00:00 AM

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Independent Insurance Claims Adjuster in Hillsboro, Missouri
  • MileHigh Adjusters Houston Inc
  • Hillsboro, MO
  • ADJUSTERS NEEDED NOW FOR ALL STORM RELATED SEASONS! Independent Insurance Claims Adjusters Needed Now! This is a HUGE op...
  • 3/28/2024 12:00:00 AM

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Claims Adjuster Trainee
  • Progressive Insurance
  • Ballwin, MO
  • Join Forbes' 2023 Best Employer for Diversity! As aclaims adjuster trainee, you'll learn how to help customers get back ...
  • 3/25/2024 12:00:00 AM

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Property Field Claims Adjuster(St. Louis, MO)
  • American Family Insurance - Corporate
  • Saint Louis, MO
  • Job Family Summary Investigates and maintains property/casualty claims. Determines liability, secures information, revie...
  • 3/25/2024 12:00:00 AM

St. Louis (/seɪnt ˈluːɪs/) is an independent city and major inland port in the U.S. state of Missouri. It is situated along the western bank of the Mississippi River, which marks Missouri's border with Illinois. The Missouri River merges with the Mississippi River just north of the city. These two rivers combined form the fourth longest river system in the world. The city had an estimated 2017 population of 308,626 and is the cultural and economic center of the St. Louis metropolitan area (home to nearly 3,000,000 people), which is the largest metropolitan area in Missouri, the second-largest ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Adjustment Clerk jobs
$32,435 to $40,280
Saint Louis, Missouri area prices
were up 0.7% from a year ago

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