About HealthSmart

HealthSmart is the premier provider of customizable and scalable health plan solutions for self-funded employers. We reduce costs and improve outcomes, all the while treating our health plan members with dignity and respect. But that's just the beginning of our story - We make differences in peoples' lives every single day!

Our HealthSmart team understands the difference we make when treating others with dignity and respect, which is why we embody our mission by promoting a diverse and inclusive culture.

We're a company of innovators.

We deliver health benefit plans and solutions to provide worry-free, self-funded plan administration, quality coverage, and innovative care.

We provide care management services that change lives and helps employers and members take control of healthcare costs.

HealthSmartRx Solutions delivers extremely attractive pharmacy benefits with an Rx discount program.

Our Network Solutions group offers national, comprehensive provider networks to provide member access to the right care.

HealthSmart Casualty Claims Solutions leverages technology, robust information and unmatched experience to deliver innovative casualty claims management solutions with outstanding results.

We offer business intelligence and web-based reporting. Plus, we offer a variety of health and wellness initiatives and even onsite employer clinics.

POSITION SUMMARY
At HealthSmart, the Claims Adjuster will directly oversee claim handling and/or processing and issuing claim payments.

Essential Functions Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

• Review new claims on designated client accounts and establish a plan of action to achieve favorable claim resolution


• Make compensability and/or liability determinations on indemnity claims


• Establish reserves, calculate indemnity benefits, pursue subrogation, report to excess carriers, and discuss strategies with legal counsel


• Consult with clients to understand their needs and goals


• Provide status reports to customers and keep Account Executives and Claims Manager informed


• Advocate, consult and provide advice to clients as appropriate


• Investigate, evaluate, and negotiate resolution of large and/or complex claims in accordance with company guideline and best claims practices

Physical Requirements

• The employee is occasionally required to walk; use hands and fingers to feel, handle, or operate objects, tools, or controls; and reach with hands and arms


• The employee must occasionally lift and/or move up to 50 pounds


• Specific vision abilities required by this job include close vision and the ability to adjust focus


• The work is performed primarily in an office setting


• The noise level in the work environment is moderate

The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position

HealthSmart provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.