About this role
Role Overview
- Responsible for reviewing and processing claims including, identifying irregularities and reviewing for accuracy, and completeness.
- Must comply with policy provisions and appropriate state and federal laws.
- Identifies claims that need additional reviews, initiates and implements the appropriate reviews.
- Initiates independent analysis of claims that need additional review.
- Manages active claims while adhering to department time service standards with quality performance.
- Gathers and reviews data from different sources; make recommendations and decisions to be reviewed by trainer/leader.
- Manages more complex claim operational activities which may include Presidential and Department of Insurance Complaints, reviewing state and federal regulations for applicability to claims, state reporting, and developing letters and forms for departmental use.
- Reviews and understands complex medical, financial records and legal documents.
- Understands and utilizes various investigative tools.
- Learns and develops an understanding of complex policies and associated claim handling process.
- Performs claims handling processes and procedures related to less complex Life, LTC, Disability, Critical Care, Accident, Hospital Indemnity and Wellness claims.
Requirements
- High School Diploma or GED with 6 years of related experience; or Bachelor’s Degree with 0 – 2 years of related experience
Benefits
- Health/dental/vision
- life insurance
- FSA and HSA
- 401(k) plan
- Employee Assistant Program
- Back-up Care for Children, Adults and Elders
- health and wellness initiatives
- Wellness program