Claim Analyst 2

Principal Financial Group • Des Moines, IA

1d • Remote

About The Position

As a Claim Analyst 2, you’ll review, analyze, and make appropriate and accurate decisions on claims in accordance to the policy and state/federal law and regulations. Analyze and adjudicate claims by gathering and reviewing all required documentation within the established approval and denial authority structure. Evaluate claim information to make timely and detailed judgments, applying knowledge of claim procedures, product development, contract provisions, and applicable state laws. Maintain complete and well-documented claim files that provide a clear and thorough audit trail for compliance and legal purposes. Identify complex or sensitive claims and refer them, with appropriate recommendations, to relevant resources such as nurses, physicians, consultants, senior claims personnel, or the Law Department as needed. Communicate with customers in a professional, timely, and helpful manner, including claimants, employers, providers, brokers, and sales offices. Provide clear written and verbal updates regarding claim decisions, claim status, and all aspects of the claims process to ensure a full understanding of the company’s position and any additional information required. Ensure claim payments are processed accurately and in a timely manner by following internal procedures and applying appropriate interpretations of contract provisions. Maintain compliance with all applicable state and federal laws and regulations across a variety of contract types. May assist in providing ongoing training, development, coaching and feedback to others.

Requirements

• 4+ years of claims or customer service experience or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education.
• General medical knowledge to support effective claim analysis and decision making preferred.
• Excellent verbal and written communication skills.
• Excellent typing skills and math skills.
• Ability to adapt to frequent change, make independent decisions and take ownership to resolve issues.
• Ability to maintain a high degree of accuracy and pay strict attention to detail.
• Strong proficiency with business unit products, processes and systems.
• Proficient with desktop applications such as MS Office and Internet browsers.
• Ability to effectively navigate within numerous software and web applications.
• Ability to handle multiple tasks in a fast-paced environment with attention to detail.
• Must be able to maintain confidentiality.

Nice To Haves

• General medical knowledge to support effective claim analysis and decision making

Responsibilities

• Review, analyze, and make appropriate and accurate decisions on claims in accordance to the policy and state/federal law and regulations.
• Analyze and adjudicate claims by gathering and reviewing all required documentation within the established approval and denial authority structure.
• Evaluate claim information to make timely and detailed judgments, applying knowledge of claim procedures, product development, contract provisions, and applicable state laws.
• Maintain complete and well-documented claim files that provide a clear and thorough audit trail for compliance and legal purposes.
• Identify complex or sensitive claims and refer them, with appropriate recommendations, to relevant resources such as nurses, physicians, consultants, senior claims personnel, or the Law Department as needed.
• Communicate with customers in a professional, timely, and helpful manner, including claimants, employers, providers, brokers, and sales offices.
• Provide clear written and verbal updates regarding claim decisions, claim status, and all aspects of the claims process to ensure a full understanding of the company’s position and any additional information required.
• Ensure claim payments are processed accurately and in a timely manner by following internal procedures and applying appropriate interpretations of contract provisions.
• Maintain compliance with all applicable state and federal laws and regulations across a variety of contract types.
• Assist in providing ongoing training, development, coaching and feedback to others.

Benefits

• Personal Time Off (PTO) is provided to hourly (non-exempt) employees and provides a set amount of accrued time earned each pay period. Employees can use their PTO for vacation, personal or short-term illness.
• Pension Eligible

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed