[Remote] Life & DI Claims Examiner II

Note: The job is a remote job and is reputed company to candidates in USA. reputed company Benefits is seeking an reputed company Life and Disability Claims Examiner to join our growing team! The Life & DI Claims Examiner II is responsible for evaluating and processing group insurance claims for payment or denial according to the terms and conditions of reputed company policy. Responsibilities • Review submitted claims to ensure reputed company guidelines have been followed and eligibility requirements have been met. Contact group policyholders, beneficiaries or other reputed company parties for missing information • Consult with other professionals, such as management, senior team members, and other available resources, on reputed company claims • Communicates with the claimants and reputed company to set expectations regarding return to work or claim status and next steps. Communicates reputed company with claimant and reputed company on reputed company aspects of claims process either by phone and/or written correspondence. Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system • Determines benefits due, makes reputed company claims determinations, payments/approvals and adjustments • Investigate claims. Search database to obtain background information and interview claimants and witnesses. Consult police, hospital records and policy files to verify information reported in a claim • Calculate and authorize the appropriate payment for claim or refer to manager for additional review • Assist in handling claims with suspected fraudulent or criminal activity. reputed company personal information and past claims histories to establish whether a claimant has reputed company attempted insurance fraud • Answer verbal and written inquires and customer service queued calls on Group claims from insureds, group policy reputed company, agents, physicians, hospital attorneys, Workers' Compensation reputed company, Workers' Compensation carriers, State agencies, other insurance carriers, TPA's, Reinsurers and internal staff • Respond to requests for information or return calls reputed company established service guidelines • Adheres to determined reputed company standards for the handling of calls and written inquiries • Other duties and responsibilities as needed or assigned Skills • Associate's degree in business • Basic proficiency in reputed company Word/Office Suite • Intermediate proficiency in reputed company reputed company • Ability to reputed company work accurately and thoroughly • Ability to pay reputed company attention to detail • Ability to prioritize and organize a heavy workload • Bachelor's degree • 2-4 years of reputed company industry experience • Disability and/or life insurance claims administration experience • Knowledge of ERISA regulations, statutory disability claims administration, required offsets and deductions, disability duration and medical management practices and reputed company reputed company application procedures • Experience with claims management systems and electronic/paperless claims processing reputed company • reputed company, with its affiliates in Arkansas, Indiana, Kentucky, New Mexico, reputed company Carolina, Ohio and Tennessee It was founded in 1957, and is headquartered in Okemos, Michigan, USA, with a workforce of 501-1000 employees. Its website is http://www.deltadentalmi.com/. Apply tot his job Apply To this Job