Claims Examiner Assistant Remote U.S.
About The Position
Essential Job FunctionsEnters insurance claims received electronically or in written form.Answers incoming customer calls regarding claim processing. Documents claim and associated history.Evaluates available information to validate claims. Verifies policyholder information, policy effective dates, premium status and verification of claim eligibility.Sends claim form to claimant for updating, correction or completion.Investigates simple to moderately complex claims and determines level or resolution if appropriate; advises claimant of status; assists in negotiating settlement and resolution of claim.Identifies need for additional information; contacts appropriate source to obtain needed information. Verifies beneficiary or claimant information if claim is warranted. Identifies payment amount and obtains required management approvals for payment. Processes payment.
Requirements
- High school diploma or G.E.D.
- Two or more years of auditing, accounting, contracts or information technology experience
- Experience working with insurance and/or medical terminology
- Experience working with appropriate claims processing procedures and documentation
- Good analytical and problem solving skills
- Good interpersonal skills to interact with team members
- Good communication skills to communicate with clients
- Good data entry skills
- Negotiation skills to interact with claimant
- Ability to keep sensitive and confidential material private
- Ability to work in a team environment
Nice To Haves
- Fellowship of Life Health Claims (FLHC) Certification preferred
Responsibilities
- Enters insurance claims received electronically or in written form.
- Answers incoming customer calls regarding claim processing.
- Documents claim and associated history.
- Evaluates available information to validate claims.
- Verifies policyholder information, policy effective dates, premium status and verification of claim eligibility.
- Sends claim form to claimant for updating, correction or completion.
- Investigates simple to moderately complex claims and determines level or resolution if appropriate; advises claimant of status; assists in negotiating settlement and resolution of claim.
- Identifies need for additional information; contacts appropriate source to obtain needed information.
- Verifies beneficiary or claimant information if claim is warranted.
- Identifies payment amount and obtains required management approvals for payment.
- Processes payment.
Benefits
- flexible vacation policy
- 401(k) employer match
- comprehensive health benefits
- educational assistance
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
