Claims Examiner (14180)

Duties of a Claims Examiner will include the evaluation, investigation, benefit calculation and processing of claims within the guidelines of policy contracts and Company procedures.

Description of Duties:

Perform various duties with a high degree of accuracy. Duties include but are not limited to evaluating claims to determine eligibility for benefits in accordance with the policy contract. Independent action and judgment decisions required. Responsible for processing claims according to Company procedures and performing necessary accounting entries required to complete claims processing. May require direct contact with policyholders, PR Representatives, Marketing Specialists, claimants, agents and/or medical providers regarding claims process. Contact is by telephone, e-mail and written correspondence. Other duties as required by the department.

Required Skills:

Required Skills:

• Minimum typing requirement of 50 wpm.
• Knowledge of coding and medical terminology.
• Skilled in performing intermediate arithmetic calculations.
• Proficiency in Microsoft Office Suite (i.e. Outlook, Excel, Word) and other basic computer programs.
• Strong organizational skills and detail-oriented approach to work.
• Excellent written and verbal communication skills.
• Ability to thrive in a fast paced environment while working independently and with limited supervision.
• Positive team oriented attitude with flexibility to adjust to changes as they arise.
• High technical aptitude with ability to learn new systems quickly.
• Knowledge of insurance industry and claims handling experience preferred.
• Score 98% or better on the Medical Terminology exam.

Required Experience:

Experience / Education:

• Must possess a High School diploma or equivalent thereof plus, 1-2 years related experience and/or training; or a Bachelor’s degree from a four-year college or university.
• Six months experience in Claims Department Data Entry & Mail Distribution Representative position (LG4) or four years in a non-entry level position (LG4 or higher).
• Advanced level testing in Microsoft Office Suite and arithmetic calculation testing.