Claims - Claims Examiner

Wellcove • PENSACOLA, FL

1d

About The Position

As a Third-Party Administrator, CHCS Services Inc. manages eight (8) Health and Life, lines of business in the Claim Department; Medicare Supplement/Select; Hospital/Indemnity; Cancer/Critical Illness; Major Medical; Life/Annuities; Long Term Care; Dental; Disability. This position is responsible for the review and adjudication of most levels of claims in accordance with policy, company, state, and federal guidelines for Medicare Supplement Insurance. This role does not involve full claim handling from claim receipt or intake to closure. In terms of claims handling, this position is specifically limited to the payment or adjudication of invoices pertaining to long term care claims.

Requirements

• Review and adjudication of most levels of claims in accordance with policy, company, state, and federal guidelines for Medicare Supplement Insurance.
• Accurate/timely daily review of Long-Term Care claims and policy provisions to process payment or issue denial.
• Identification, analysis and application of long-term care claim product features including waiver of premium, waiting period, assignment of benefits, credits, and other applicable policy benefits.
• Meet or exceed minimum production and quality targets as approved by management.
• Respond accurately, timely and professionally to all oral and written external and/or internal correspondences received from stakeholders in regard to benefits, eligibility, claim payments, denials and/or explanation of benefits. As well as inbound claim calls.
• Maintain working knowledge of all company services pertaining to business segment, company claims, administrative and imaging software systems such as INSPRO and Microsoft applications.
• Operate within company regulations regarding HIPAA, fraud, confidentiality, and private health information guidelines.

Responsibilities

• Accurate/timely daily review of Long-Term Care claims and policy provisions to process payment or issue denial.
• Identification, analysis and application of long-term care claim product features including waiver of premium, waiting period, assignment of benefits, credits, and other applicable policy benefits.
• Meet or exceed minimum production and quality targets as approved by management.
• Respond accurately, timely and professionally to all oral and written external and/or internal correspondences received from stakeholders in regard to benefits, eligibility, claim payments, denials and/or explanation of benefits. As well as inbound claim calls.
• Maintain working knowledge of all company services pertaining to business segment, company claims, administrative and imaging software systems such as INSPRO and Microsoft applications.
• Operate within company regulations regarding HIPAA, fraud, confidentiality, and private health information guidelines.
• Other duties as assigned.

What This Job Offers

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