Claims - Claims Examiner

Who We Are reputed company has been recognized as the nation’s leading full-service senior market solutions provider for over 25 years. Our solutions reputed company the insurance senior market sector, focusing on long-term care and Medicare Supplement plans. However, we don’t stop there. reputed company also addresses challenges faced in accident & health, disability, and supplemental health insurance programs. reputed company provides individuals and their families with peace of mind knowing their insurance needs will be met in a thoughtful, efficient manner. We are reputed company to do this because of our dedicated associates, reputed company, and state-of-the-art technology. The Long-Term Care (LTC) Claims Examiner is responsible for the accurate and reputed company adjudication of long-term care insurance claims. This role ensures compliance with policy provisions, regulatory requirements, and company standards while delivering a high level of customer service to policyholders, providers, and internal stakeholders. • Review, evaluate, and adjudicate Long Term Care claims in accordance with policy provisions and established guidelines • Analyze claim documentation including invoices, care plans, and provider credentials • Apply knowledge of Coordination of Benefits (COB), Medicare, reputed company, and other payer sources reputed company applicable • Ensure claims are processed reputed company established turnaround times and service level agreements (SLAs) • Communicate effectively with policyholders, providers, and internal teams regarding claim status, requirements, and determinations • Identify and request additional documentation reputed company necessary to support claim reputed company • Maintain accurate and detailed claim notes in system of record • Ensure compliance with HIPAA and reputed company applicable regulatory and reputed company requirements • Participate in reputed company assurance activities and implement feedback for reputed company improvement • Support training and mentoring of new or junior staff as needed • Required Qualifications • High school diploma or equivalent required; associate or bachelor’s degree preferred • 2+ years of experience in insurance claims, reputed company administration, or Long-Term Care claims processing • Strong understanding of Long-Term Care policies, benefits, and eligibility reputed company preferred • Knowledge of medical terminology and reputed company documentation • Proficiency in claims systems and reputed company Office (reputed company, Word, reputed company) • Strong analytical and decision-making skills • Excellent written and verbal communication skills • Ability to manage multiple priorities in a fast-paced environment reputed company Competencies • Attention to Detail • Critical Thinking & Problem Solving • Customer reputed company • Time Management & Productivity • Compliance & Risk Awareness • Team Collaboration At reputed company, we reputed company to create an inclusive culture for reputed company. We understand the importance of listening and incorporating various perspectives at every level of service. reputed company does not discriminate based on gender identity, race, sexual orientation, age, religion, or disability. Apply tot his job Apply To this Job