Job Description:
• Develop proficiency in handling all aspects of assigned claims
• Process claims for payment or denial according to policy terms and conditions
• Receive and maintain reports
• Guide beneficiaries through the claim process
• File for reinsurance
• Provide customer service to internal and external customers
• Review submitted claims for adherence to guidelines and eligibility requirements
• Contact policyholders, beneficiaries, or third parties for missing information
• Participate in scheduled queue call handling and dedicated client telephone calls
• Respond to basic inquiries and explain claims requirements and decisions
• Process assigned claims through claims processing systems
• Create claims files and enter claims data and payments into applicable systems
• Process and distribute paper and electronic mail and faxes
• Prepare claims documents for imaging and maintain statutory files accurately
• Follow up on outstanding requirements and comply with regulatory and state requirements
• Distribute claim documents to assigned claim examiners
• Assist with claims account reconciliation and provide backup support
• Claims Examiner: investigate claims, interview claimants and witnesses, and verify information using police, hospital, and policy records
• Claims Examiner: consult lawyers and physicians on complex claims
• Claims Examiner: assist with suspected fraudulent or criminal activity
• Address inquiries from insureds, policyholders, agents, physicians, hospitals, attorneys, regulators, carriers, reinsurers, and internal staff
• Analyze claim reports and take action on prioritized cases
• Set up incoming claims and process daily mail within required standards
• Complete follow-up and resolve claims within state, federal, and internal time guidelines
Requirements:
• Associate’s degree in business required; degree in a related field is acceptable
• Associate Claims Examiner: 2–3 years of related experience required
• Associate Claims Examiner: 1–2 years of life insurance experience required
• Experience in a customer service or insurance industry environment required
• Intermediate experience with Microsoft Excel required
• Basic experience with Microsoft Word required
• Claims Examiner: 3–5 years of related experience
• Claims Examiner: 3–5 years of life insurance experience required
• Claims Examiner: Administration experience required
• Familiarity with medical terminology and Company products strongly preferred
• Industry-recognized certifications preferred
• Experience with Sigma, E-Records, Life Support Plus, Freedom, and Lotus Notes strongly preferred
• Visa sponsorship is not available for this position
Benefits:
• Competitive salary and benefits
• Telecommuting flexibility may be available
• Relocation assistance is not available
• Visa sponsorship is not available