Claims Examiner

SILAC Insurance Company•Salt Lake City, UT

About The Position

Perform claim processing for long term care (LTC) insurance claims and support the overall Long-Term Care Department. This work requires competent customer communication, evaluation of complex information, knowledge of insurance policies, and use of Long-Term Care Department operational procedure guides.

Requirements

Ability to research and logically consider details from many sources, and to bring them together to support a conclusion.
Ability to accurately communicate in written format and verbally.
Experience using mainframe computer and/or with PC applications such as MS Word or Outlook.
High school diploma, GED, or any combination of education, professional training, or work experience that demonstrates ability to do the job.
Decision making and problem solving.
Sharp math aptitude with general accounting.
Establish and maintain effective working relationships.
Plan and organize work effectively.

Nice To Haves

Previous Long Term Care (LTC) or other insurance claim processing experience.
Knowledge of medical terminology and coding such as ICD-10 diagnosis codes.

Responsibilities

Obtain all necessary information such as diagnosis codes, admit & discharge dates, and charges for services.
Review claims for missing information and/or errors based on claim forms received and corresponding documentation (i.e. invoices, care notes, etc).
Enter data per policy guidelines.
Study and learn policy requirements across different products and different States.
Review Standard Operating Procedures to ensure clear knowledge of correct claims processing, calculations, data entry and document retention.
Make phone calls to facilities for clarification regarding claims submissions.
Collaborate with coworkers and supervisors.
Report to and perform other work or projects as directed by the Claims Manager.