Senior Claims Examiner (REMOTE)

American IT Systems•Atlanta, GA

5d•Remote

About The Position

This is a remote, 3-month contract position with possible extensions for a Senior Claims Examiner. The role involves reviewing and assessing supplemental health claims to determine eligibility based on policy terms and conditions. Responsibilities include gathering documentation, analyzing medical records and employment history, communicating with claimants and stakeholders, and ensuring accurate record-keeping and compliance with regulations.

Requirements

High school diploma or equivalent
Claims operations experience for Group disability, Employee Benefit, Worker Compensation, Claim Management, Overpayment Recovery, or Leave Management
6-18 months Life Insurance backend operations experience

Nice To Haves

Strong English Communication (Both written & verbal)
Proactive communication
Multi-tasking ability
Time management
Attention to detail
Displays energy, enthusiasm, and flexibility in approaching the job
Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
Customer service focus
Basic Computer knowledge along with typing speed of 40 words/minute
Insurance knowledge

Responsibilities

Review and assess supplemental health claims to determine eligibility based on policy terms and conditions.
Gather necessary documentation from claimants, medical professionals, and other relevant sources to support the claim evaluation process (quantitative review).
Analyze medical records, employment history, and other pertinent information to make informed decisions (qualitative review).
Communicate with claimants to provide updates on their claim status and request additional information when needed.
Collaborate with healthcare providers, employers, and other stakeholders to ensure accurate and timely processing of claims.
Maintain clear and professional communication with all parties involved in the claims process.
Ensure all claim-related documents are accurately recorded and stored in the workflow systems for future reference.
Prepare detailed reports and summaries of claims for internal review and decision-making purposes.
Maintain confidentiality and adhere to data protection regulations when handling sensitive information.
Ensure compliance with industry regulations, company policies, and legal requirements throughout the claims process.
Conduct regular audits of claims files to ensure accuracy, completeness, and adherence to standards.
Participate in training sessions to stay updated on changes in policies, procedures, and regulations.