Claims Examiner- Voluntary Benefits

Accenture•San Antonio, TX

1d•Remote

About The Position

The Voluntary Benefits Claims Examiner will support a large Group Insurance Business contract and is responsible for the calculation of Voluntary Benefits across limited products according to Plan Provisions. Voluntary Benefits can include wellness, hospital indemnity, accident and critical illness products. This position requires the knowledge and understanding of Voluntary Benefits policies and procedures with a medical terminology background and ability to read medical records outside of ICD’s, CPTs and HCPC to appropriately calculate the benefits due. You will be expected to follow through timely on claim processing, utilize judgment, and assess risk when rendering claim decisions. Able to communicate with various constituents with limited guidance and learn and transact using the client s systems. Expected to communicate clearly concisely to influence return to work, discuss terms of the certificate, and the basis of payment nonpayment.

Requirements

Minimum of 6 months experience in Medical Insurance Claims Processing
Minimum of 1 year experience in a contact center/call center.
Proficiency in Windows environment, including Word and Excel
Medical terminology knowledge
Strong written and verbal communications required
Detailed oriented with strong time management skills
Schedule flexibility to work a schedule from 7 am to 7 pm CST
Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.

Nice To Haves

Group Life/Disability/ Voluntary Claims experience
Bachelor's Degree
NY Adjustor License
Strong mathematical skills

Responsibilities

Document all claim information including phone calls and correspondence.
Utilize effective communication to obtain information both verbally and in writing and provide information to the claimant and employer.
Ability to read multiple pages of medical records to confirm benefits available to the member.
Ability to apply plan provisions understand the needs of the clients.
Expected to adhere to client Service Level Agreements and department s product s key performance requirements and any reporting.
Able to utilize strong organizational skills to manage multiple priorities while working under tight time constraints, possess the ability to work through ambiguity, and work effectively with various vendors with strong interpersonal skills.
Willing to support special internal functional projects and ad hoc requests as required.
Able to work cohesively with Subject Matter experts to support the day to day tasks, able to anticipate, identify, and resolve complex issues problems.
Able to communicate risks issues to supervisor and help with the resolution, as needed.
Provide exceptional customer service either over the phone or through email.
Able to provide leadership updates progress reports on training curriculum.
Utilize tools independently and accurately to identify work to be completed.
Professional and detailed verbal skills for outbound calls to obtain medical records or claim details to gather data to work claim to completion.