Health Claims Examiner

Location - Lombard, IL (3 days a week onsite) Our client is looking to add a Supplemental Health Claims Examiner that will be responsible for analyzing, processing, and recommending approval or denial of Hospital Indemnity, Critical Illness/Specified Disease, Accident Insurance, Life product claims, and weekly income claims on various policies with a variety of related duties. Job Responsibilities: Adjudicate Accident Insurance, Critical Illness/Specified Disease, Hospital Indemnity Life product claims and weekly income claims in accordance with established policies and procedures. Consistently adhere to the documented workflow guidelines and established procedures. Calculate multiple benefits due based a combination of information on claim forms, medical information, plan certificates/contract and regulatory guidelines and administer provisions accurately, including, but not limited to, misrepresentation or pre-existing Investigation, Evidence of Insurability Review, Benefit Entitlement Review, Financial Accuracy, ERISA Guidelines, MAR Requirements, State Regulations, Company Financial Liability as applicable. Proactively and efficiently obtain complete and accurate information from groups, agencies, physicians, beneficiaries, claimants, etc., to verify and ensure claim eligibility and resolve investigation issues. Maintain or exceed Department production, quality, and service level standards consistently. Provide professional, prompt, and accurate customer service via telephone and in writing to members, groups, doctors, etc., in handling various claim types. Assume responsibility for all assigned claims to review and resolve customer issues/problems and complaints promptly. Investigate, research, and verify information on all claim types to confirm eligibility and ensure sufficient/adequate information is obtained related to benefits being claimed. Maintains required levels of confidentiality. Provide effective verbal and written communication by involving appropriate parties within, or outside the department or company to professionally represent the company in all interactions. Maintain accurate documentation of activities and telephone conversations in claim file in accordance with company practices and procedures. Maintain thorough knowledge of all policies, statutes and regulations, medical conditions, and departmental procedures to ensure proper dispositions of claims. Recommend changes to management to avoid recurring customer inquiries/problems. Fully investigate all relevant claim issues, provide approvals, payments, or denials promptly and in full compliance with departmental procedures and Unfair Claims Practice regulations. Required Job Qualifications: Associate’s or Bachelor’s degree or 0-2 years of equivalent business/related work experience. Good decision-making, problem solving and research skills with ability to analyze complex information. PC proficiency to include MS Word, Excel, SharePoint, and Outlook. Detail oriented with ability to maintain high level of quality and accuracy in a fast-paced environment. Clear and concise verbal and written communication skills. Knowledge of medical terminology Preferred Job Qualifications: HIAA, LOMA or ICA courses a plus. Aptitude for math and critical thinking skills. Ability to fluently speak and write Spanish a plus. The anticipated hourly rate range for this position is ($22-25/hr). Actual hourly rate will be based on a variety of factors including relevant experience, knowledge, skills and other factors permitted by law. A range of medical, dental, retirement and/or other benefits are available after a waiting period. #J-18808-Ljbffr IT Associates