Health Insurance Adjustor

Make sure health insurance claims tally with the services rendered.

What does a Health Insurance Adjustor do?

Have you ever experienced seeing a Doctor for a procedure you thought would be covered by your health insurance, then-surprise, surprise-you get a huge bill for it two months later? Chances are a Health Insurance Adjustor determined that your treatment was not commensurate with your diagnosis, and they issued a limited payment to your Doctor.

A Health Insurance Adjustor works for a health insurance company, evaluating claims and determining whether they tally with the treatments received. When you’re a Health Insurance Adjustor, most claims submitted to your insurance company go through the Insurance Examiner ‘s hands first. But if something doesn’t look good with a particular claim, a report will be prepared and handed to you. It is your job to evaluate the information on the claim, and based on it, as well as on research about the diagnosis and its customary treatment, you make an estimate on how much, if any, will be remitted to the patient’s healthcare provider.

This is a job for individuals who don’t balk at making decisions that aren’t necessarily warm and fuzzy. When you’re the one who has to decide not to give a claimant full coverage, you don’t exactly end up as Mr. or Ms. Popularity. But even if you have to make difficult calls, you get satisfaction in knowing that you’re working to ensure Doctors take the time to make the right medical diagnoses and prescribe the most efficient treatment.