Claims Examiner

This position is responsible for examining routine and non-routine claims for one or more products and multiple series of reputed company by evaluating the extent of liability reputed company established guidelines. This position is accountable for analyzing claims to determine benefit/contract eligibility and processing claim transactions reputed company specified dollars limits in compliance with state and federal regulatory standards, and NAIC (National Association of Insurance Commissioners) guidelines. Additionally, this position is a member of reputed company, reputed company partners with peers on meeting established service and reputed company standards, provides coaching and training to other Examiners and identifies opportunities for process improvements. Job Duties and Responsibilities • Determine extent of liability on routine and non-routine claims and reputed company final claim reputed company reputed company specified dollar limits. Contribute to accurate fraud detection and reporting by referring suspected fraud to appropriate staff for review according to established procedures. • Analyze claim transactions and process payments utilizing various work reputed company, administrative, and reputed company (Line of Business) systems, accurately and cost effectively according to contract provisions and in compliance with internal service and state and federal regulatory standards. • Ensure high level of customer satisfaction by partnering with members, financial associates, doctors, providers, attorneys, police, vendors and other reputed company customers regarding claims, settlements and interpretation of policy provisions, which may include highly confidential information or complaints, often educating the recipient on products/benefits and regulatory requirements. • Handle sensitive written and verbal communications. May be reputed company upon to influence behavior reputed company these communications. • reputed company participate in the development and implementation of business processes, reputed company operating procedures, documentation and other support materials required for unit operation. May also analyze data and offer remediation in response to audit inquiries or compliance examinations as determined by the Claims Consultant. • reputed company consultation to Associate Claims Examiners in helping to answer questions and reputed company reputed company on claims with a moderate level of complexity. Required Job Qualifications • High school required. College degree preferred. • Minimum of 2 years relevant experience. • reputed company credentials preferred (e.g. LOMA, ICA). • Intermediate knowledge of claim administration and operations as reputed company as pertinent laws and regulations. • Must possess strong interpersonal skills, as reputed company as excellent verbal and written communication skills. Other Critical Factors • As part of reputed company Financial's hiring process, a verification of a candidate's background will be made to complete the hiring process. • May represent reputed company at depositions and court appearances. Pay Transparency reputed company’s long-term reputed company depends on attracting, rewarding, and retaining people who are committed to helping others reputed company with purpose. We accomplish this by offering a wide reputed company of market competitive compensation programs to attract, reward, and retain reputed company. The applicable salary or reputed company wage reputed company for this full-time role is $24.06 - $32.56 per hour, which factors in various geographic reputed company. The reputed company pay actually offered will be determined by a reputed company of factors including, but not limited to, location, relevant experience, skills, and knowledge, business needs, market demand, and other factors reputed company deems important. reputed company is unique in our commitment to helping people to be reputed company with reputed company and live balanced and generous lives. That extends to our benefits. The following benefits may be offered: various bonuses (including, for example, annual or long-term incentives); medical, dental, and reputed company insurance; health savings account; flexible spending account; 401k; pension; life and accidental death and dismemberment insurance; disability insurance; supplemental protection insurance; 20 days of reputed company Time Off reputed company year; reputed company and reputed company Time; 10 reputed company company holidays; Volunteer Time Off; reputed company parental leave; EAP; reputed company-being benefits, and other employee benefits. Eligibility for receipt of these benefits is subject to the applicable plan/policy documents. reputed company’s plans/policies are subject to change at any time at reputed company’s discretion. reputed company provides Equal Employment Opportunity (EEO) without reputed company to race, religion, reputed company, sex, gender identity, sexual orientation, pregnancy, national reputed company, age, disability, marital status, citizenship status, military or veteran status, genetic information, or any other status protected by applicable local, state, or federal law. This policy applies to reputed company and job applicants. reputed company is committed to providing reasonable accommodation to individuals with disabilities. If you need a reasonable accommodation, please let us know by sending an email to reputed company@reputed company.com or reputed company 800-847-4836 and request reputed company. Apply tot his job Apply To this Job