Position: Claims Examiner

Location: Multiple Locations (Hybrid)

Duration: 06 Months Contract to Hire

JOB DESCRIPTION

• Locations are “Lombard, Richardson, Portland Maine, Southfield and Houston” (Hybrid) (Training is also onsite).
• Under supervision, this position is responsible for examining and processing all claim types including short term or long term disability, life, waiver of premium, critical illness, accident insurance and other claim type for various policies. May perform a variety of related duties or travel to client sites to discuss / resolve claim issues.

ESSENTIAL JOB FUNCTIONS

• Assume responsibility for all assigned large accounts and sensitive groups to review and resolve customer problems and complaints concerning claims matters and personally handles the claim through resolution.
• Proactively communicate and respond to claim inquiries from insureds, beneficiaries, policyholders and internal stakeholders; resolve issues through effective verbal and written communication by involving appropriate people within, or outside the department or company; effectively and professionally represent the company in all interactions.
• Relieve and complete work assignments for other Claim Representatives during absences, etc. to stay within the Department's established turnaround schedule.
• Investigate, research, verify and diligently obtains medical information on all claim types to determine eligibility and interpret information relating to the severity of the stated disability or incident.
• Adjudicate claims in accordance with established policies and procedures.
• Interview, make calls and/or corresponds with customers to determine extent of customer concern and resolves situation in accordance with standard operating procedures.

QUALIFICATION

• Bachelor degree or 4 years of business experience.
• 2 years of claims experience.
• Problem solving and research skills.
• PC proficiency to include Word, Excel, PowerPoint, Outlook and Lotus Notes.
• Customer Service experience.
• Organizational skills.
• Experience handling multiple tasks and making priorities.
• Clear and concise verbal and written communication skills.
• Proficient in the following: Correspondence, Medical Records Review, Misrepresentation Investigation, Pre-Existing Investigation, Evidence of Insurability Review, Benefit Entitlement Review, Financial Accuracy, ERISA Guidelines, MAR Requirements, State Regulations, Contract Language, Company Financial Liability.
• Experience in the following core systems: ECM, STAR (Claim System), Genelco/GIAS, Siebel, UTS, Casetrak, Docsql, Benefits Manager, and ImagePlus.
• Experience processing one (1) of the following claim types: Life or Waiver of Premium claims.
• Experience in processing any of the following two (2) claim types: Critical Illness/Specified Disease, Accidental Insurance, GAP, Permanent and Total Disability (PTD benefits, Accidental Death and Dismemberment, Permanent and Total Disability (PTD), Accelerated Death Benefits.

Job Type: Full-time

Pay: $20.00 - $23.00 per hour

Physical setting:

• Office

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Education:

• High school or equivalent (Required)

Experience:

• Claims: 3 years (Required)
• Life or Waiver of Premium claims: 2 years (Required)

Work Location: In person

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