Supplemental Health Claims Examiner - Remote

Symetra • ,

33d • $22 - $37 • Remote

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 critical illness, hospital indemnity and scheduled or group accident claims. 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.

Requirements

• 1-3 years of cumulative, relevant experience
• Extensive knowledge of supplemental health products and the ability to interpret policy language for critical illness, hospital indemnity, and scheduled or group accident claims.
• Proficient in reviewing medical records, itemized bills, and standard claim forms such as the UB‑04 and HCFA 1500.
• Exercises initiative and independent judgment while working within established procedural guidelines.
• High school diploma required.
• Applicants must be currently authorized to work in the United States at hire and must maintain authorization to work in the United States throughout their employment with our company.
• Minimum Internet Speed:100 Mbps download and 20 Mbps upload, in alignment with the FCC's definition of "broadband."
• Internet Type:Fiber, Cable (e.g., Comcast, Spectrum), or DSL.
• Not Permissible:Satellite (e.g., Starlink), cellular broadband (hotspot or otherwise), any other wireless technology, or wired dial-up.

Responsibilities

• Make timely, accurate, and customer-focused claim decisions.
• Reach out to obtain relevant information from multiple sources as needed on a claim-by-claim basis. This may include making contact with healthcare providers and claimants.
• Reviewing medical records, itemized bill, UB-04 or HCFA 1500, and adjudicating benefits for one claimant with multiple lines of coverage.
• Compare the information received to the terms, limitations, and conditions of the contract and applicable procedural documents and render the claim decision as quickly as possible.
• Document the claim systems in an accurate and comprehensive manner while maintaining maximum levels of efficiency.
• Prepare and disseminate articulate written and verbal communication to assorted internal and external sources. Prepare, update, and utilize a claim management plan to attain the most appropriate outcome.
• Remain in full compliance with ERISA, HIPAA, Fair Claim Settlement Practices Acts, and other statutory regulations.
• Demonstrate proficiency in supplemental health products and claim administration techniques. Remain fully compliant with operational standards. Meet or exceed claim team operational metrics.
• Maintain a superior level of genuine caring and empathetic customer service throughout all interactions. Anticipate customer needs and take action.
• Quickly resolve issues or concerns with payments, voids and refunds.
• Work as a team to support one another through flexibility, collaboration, creating a positive work environment, consistently maintaining professionalism and integrity, actively taking steps to foster high morale, and demonstrating a dedication to excellence.

Benefits

• Flexible full-time or hybrid telecommuting arrangements
• 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: Mid Level
• Education Level: High school or GED