SB Claims Examiner

Symetra

16d • $30 - $50 • Hybrid

About The Position

The Claims Examiner is responsible for accurate and timely adjudication of complex professional, facility, and ancillary claims. This role makes timely, accurate, and customer-focused claim decisions for supplemental health products that may include limited benefit medical (LBM), critical illness, hospital indemnity, scheduled or group accident, and/or minimum essential coverage (MEC) products. Proactively reach out to internal and external sources to gather relevant medical, financial, legal, and/or general data, compare it to the applicable contract and procedural documents, conduct an analysis, and engage peers and management as appropriate. Communicate verbally and in writing and fully leverage the claim system with accurate and comprehensive information. Maintain performance within departmental metrics. The level of independent judgement assigned to this position increases over time.

Requirements

• High School Diploma required; college degree preferred.
• 1-3 years of cumulative, relevant experience.
• Ability to review and interpret policy language.
• Experience with claim forms ideal.
• Experience reviewing medical records.

Responsibilities

• Provide timely, accurate, and client-centered claim resolutions. Contact necessary parties to obtain information on a claim-by-claim basis. This process could involve engaging with healthcare providers, being responsible for coordination of benefits (COB) claims, and processing group benefits for claimants holding multiple coverage types.
• Review the information against the terms, limitations, and conditions of the contract and applicable procedural documents and provide the claim decision as promptly as possible. Record the claim systems accurately and comprehensively while ensuring maximum efficiency.
• Prepare and present clear written and verbal communication to various internal and external groups. Develop, revise, and implement a claim management plan to achieve the most appropriate result.
• Adhere strictly to regulatory requirements. Show proficiency in supplemental health products and claim processing techniques. Maintain alignment with operational standards. Achieve or surpass claim team operational goals.
• Maintain a superior level of genuine caring and empathetic customer service throughout all interactions. Take appropriate actions to earn the claimant’s and employer’s trust and confidence. Quickly resolve issues or concerns with payments, voids, refunds, and re-pricing issues.
• Support one another by working flexibly and collaborating. Foster a positive work environment while maintaining professionalism and integrity. Take active steps to improve morale and demonstrate dedication to excellence. Perform additional special projects or tasks as assigned by the Sr. Unit Manager.

Benefits

• Flexible full-time or hybrid telecommuting arrangements.
• Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6%.
• Paid time away including vacation and sick time, flex days and ten paid holidays.
• Give back to your community and double your impact through our company matching.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED