Claims Examiner

Kuvare Holdings•Lincoln, NE

13d

About The Position

Claims Examiners are confident decision-makers, playing an important oversight role in the claims process. To process, monitor, review and approve/deny living benefits and death claims. This includes reviewing medical information and case history to determine if additional investigation is required. Inform, notify, educate, and communicate with agents, insureds/claimants, beneficiaries, and internal departments. Monitor and maintain claims computer systems and reports for accuracy and efficiency

Requirements

Strong organizational skills with elevated level of attention to detail
Demonstrated persistency and ability to deliver results under pressure
Excellent interpersonal, verbal communication and proofreading skills
Proficient in Microsoft Office, etc.
Must be a flexible self-starter who can prioritize tasks, follow through and meet deadlines
Ability to work independently with minimal supervision
Strong risk assessment and conflict resolution skills.
Ability to read and interpret contract language
Normal office working environment, full time with some flexibility
Occasional evening and weekend hours to meet deadlines
Ability to type / perform data entry
Ability to read from a computer screen and paper reports
Express ideas and otherwise communicate with the spoken word

Responsibilities

Review claims reports and mail. Analyze investigative material for coverage to determine if claim is to be paid or denied, and if policy/certificate needs to be reformed/rescinded.
Maintain contact with agents and corporate legal counsel as needed.
Process payments and correspondence on a timely basis to ensure accurate and prompt processing.
Review new claims and determine if coverage is in force and claim is valid. Set up file; request additional information needed. Initial review includes reinsurance participation, contestability, beneficiary designations, coverage exclusions. Conclude what, if any, benefit applies and the amount to be reimbursed.
Organize work/resources to accomplish objectives and meet deadlines
Maintain compliance with federal and state regulations
Maintain the privacy and security of all confidential and protected information; use and disclose only that information which is necessary to perform the function of the job
Demonstrate the willingness and ability to work collaboratively with other key internal and external staff to obtain necessary information from both internal and external partners.
Participate in all educational activities and demonstrate personal responsibility for job performance
Take initiative for learning new skills and willingness to participate and share expertise on projects, committees and other activities, as deemed appropriate
Consistently demonstrate a positive and professional attitude at work
Deliver a high standard of service and empathy when following up with customers by letter, email, or telephone once the claim has been resolved.
Efficiently answer incoming telephone or email inquiries from customers about the status of their claim, striving for excellence at every touchpoint.
Work with other departments to maintain and update claims systems and ensure accuracy of reports. Maintain relationships with beneficiaries, agents, insureds/claimants, and creditors.
Accurately research discrepancies and be responsible for escalating questionable claims to your manager.