About Our Company

The Laborers Funds Administrative Office of Northern California, Inc. is a not-for-profit corporation providing administrative services under contractual agreements for Northern California Laborers Trust Funds. We employ over 100 employees and provide services for over 30,000 Laborers and beneficiaries in the various employee benefit plans we have administered since 1963.

Role Overview

We are seeking a medical Claims Adjuster to join our team and deliver outstanding administrative support and customer service to union Laborers and their families.

Job Description

A medical Claims Adjuster is responsible for administering union-negotiated fringe benefits (health and welfare) in accordance with plan documents, with a primary focus on processing medical claims in a fast-paced, high-volume environment. This role involves frequent interaction with members, providers, and partnership vendors to ensure effective communication and resolution of claim-related matters. The adjuster processes medical claims accurately and efficiently, provides excellent customer service by phone and in person to members and their families, and communicates policies, regulations, and benefit information clearly. The adjuster responds to correspondence and inquiries from members, dependents, and providers, collaborates with providers and vendors to resolve claim issues, prepares reports, and assists with special tasks and projects related to claims. Additional responsibilities include responding to legal inquiries, including subpoenas, verifying and updating eligibility with network vendors, assisting and resolving issues on behalf of members, and performing additional duties as assigned by supervisors or management. The adjuster must monitor and adapt to frequent changes and evolving requirements in regulations, organizational guidelines, and medical insurance policies or laws that may impact claims and operations. The adjuster must also be able to independently research updates in medical coding and medical policies.

Qualifications

Strong organizational and communication skills
Two years of prior experience in medical claims processing and customer service
Preferred Bi-lingual in Spanish
Ability to work independently and within a high-paced, team-oriented environment
Proficient in MS Suite (Outlook, Excel, Word) and computer systems and applications
Ability to multi-task, prioritize and meet deadlines
Self-motivated and remain calm under pressure
Analytical and detail-oriented with attention to accuracy
Flexible and adaptable to changes
Ability to independently research and remain current on medical coding and policy changes
Discretion with ability to maintain confidentiality
Strong interpersonal skills in working with employees, members and other departments
Basic understanding of call center ACD and IVR systems

What You’ll Love

Medical, dental and vision coverage paid by the employer
An employee Pension and Annuity plan contributed into by the employer
Optional participation in a 401K plan
Sick, vacation time, 8 major holidays, and 2 annual floating holidays under a Collective Bargaining Agreement

Conditions of Employment

150‐day probationary period
Microsoft Office Suite Testing is required
Work under Collective Bargaining Agreement
Union job with union dues (http://www.opeiu29.org/)
Fringe Benefits Administered by Laborers Trust Funds (https://norcalaborers.org/)
Background check and drug testing

Work Environment

Moderate noise level is typical of an office environment

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CLAIMS ADJUSTER