Claims Representative

ProspectBlue has partnered with a growing financial institution looking to add a Critical Illness Claims Representative to their team on a contract-to-hire basis. This role is responsible for interpreting policy language, reviewing medical documentation, and processing complex Critical Illness claims while providing exceptional customer service and ensuring compliance with regulatory standards. Key Responsibilities Review, analyze, and adjudicate Critical Illness claims, including approvals, denials, and requests for additional information. Interpret policy language, medical records, and clinical documentation to determine benefit eligibility. Communicate claim decisions with empathy and professionalism, including handling sensitive customer conversations. Manage assigned claims while meeting service level expectations. Collaborate across departments to resolve issues, improve processes, and support customers. Maintain compliance with company policies and regulatory requirements. Qualifications Experience with Voluntary Critical Illness claims preferred. Strong knowledge of medical terminology and experience reviewing complex medical records. Excellent analytical, critical thinking, and problem-solving skills. Strong written and verbal communication abilities. Proficiency with claims processing systems and Microsoft Office (Excel, Word, Outlook). Ability to prioritize work, manage multiple systems, and thrive in a collaborative, fast-paced environment. Location: Hybrid – Minneapolis, MN (2 days/week onsite) #J-18808-Ljbffr