Claims Examiner

ManhattanLife Insurance & Annuity Company • Houston, TX

11d • Hybrid

About The Position

The Entry Level Customer Claims Advocate will support our organization's Claims team. Our Customer Claims Advocate will evaluate and process medical claims submissions while also proactively assisting the Insured to obtain documents from medical providers and their primary insurance company. When the need arises a Customer Claims Advocate will demonstrate excellent service to resolve customer inquiries and issues in a timely manner. On the job training will be provided to the candidates that are selected for this position.

Requirements

• Solid knowledge of ICD9, ICD-10 or medical coding.
• Understanding of basic medical terminology.
• Ability to multitask while using various computer applications.
• Ability to read and understand policy language.
• Ability to work independently and in a team environment.
• Professional able to project a clear, confident and friendly voice on the phone understanding that our customers are reaching out to get an answer or request service at an important time in their lives.
• Inbound customer service experience, preferably in an insurance or financial setting.
• Intermediate Word and Excel skills are preferred.

Nice To Haves

• Experience working with insurance or working in a financial setting is preferred but not required.
• The successful completion of LOMA designations is also preferred but not required.
• Prior medical health insurance experience is a plus.
• Call center experience is a plus.
• Bilingual is a plus as we have many customers who prefer to speak Spanish.

Responsibilities

• Process insurance claims with adherence to company policies and contract provisions in full accordance with the law.
• Research complex claims previously or currently being processed and explain benefit details.
• Evaluate claims based on documentation received and provide timely follow-ups for claims being adjudicated.
• Coordinate with our Insured, their medical provider or primary insurance company for required documentation.
• Answer inbound calls to educate and assist customers regarding their claim as needed.
• Handle escalated calls with empathy and dedicated service.
• Make decisions and ensure the successful resolution of inquiries and complaints by preparing accurate and timely activity reports.
• Communicate via written correspondence or e-mail to claimants.

Benefits

• On the job training will be provided to the candidates that are selected for this position.
• Establish annual objectives for professional growth.
• Keep pace with developments in the discipline.
• Learn and apply technologies that support professional and personal growth.
• Participate in the evaluation process.

What This Job Offers

• Career Level: Entry Level
• Education Level: Associate degree