Claims Examiner- Voluntary Benefits

The Voluntary Benefits Claims Examiner will support a large Group Insurance Business contract and is responsible for the calculation of Voluntary Benefits across limited products according to Plan Provisions. Voluntary Benefits can include wellness, hospital indemnity, accident and critical illness products. This position requires knowledge and understanding of Voluntary Benefits policies and procedures with a medical terminology background and ability to read medical records outside of ICD’s, CPTs and HCPC to appropriately calculate the benefits due. You will be expected to follow through timely on claim processing, utilize judgment, and assess risk when rendering claim decisions. Able to communicate with various constituents with limited guidance and learn and transact using the client’s systems. Expected to communicate clearly concisely to influence return to work, discuss terms of the certificate, and the basis of payment nonpayment. Key Responsibilities Document all claim information including phone calls and correspondence. Utilize effective communication to obtain information both verbally and in writing and provide information to the claimant and employer. Read multiple pages of medical records to confirm benefits available to the member. Apply plan provisions and understand the needs of the clients. Adhere to client Service Level Agreements and department product key performance requirements and any reporting. Utilize strong organizational skills to manage multiple priorities while working under tight time constraints, and work effectively with vendors. Support special internal functional projects and ad hoc requests as required. Collaborate with Subject Matter experts to support day-to-day tasks and resolve complex issues. Communicate risks and issues to supervisor and help with the resolution, as needed. Provide exceptional customer service over the phone or email. Provide leadership updates on progress reports and training curriculum. Utilize tools independently and accurately to identify work to be completed. Conduct outbound calls to obtain medical records or claim details to gather data to work claim to completion. Basic Qualifications Minimum of 6 months experience in Medical Insurance Claims Processing Minimum of 1 year experience in a contact center/call center. Preferred Qualifications Group Life/Disability/Voluntary Claims experience Bachelor's Degree NY Adjustor License Strong mathematical skills Professional Skills Proficiency in Windows environment, including Word and Excel Medical terminology knowledge Strong written and verbal communications required Detail oriented with strong time management skills Job Requirement Schedule flexibility to work a schedule from 7 am to 7 pm CST. Equal Employment Opportunity Statement We believe that no one should be discriminated against because of their differences. All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law. Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities. Accenture is an EEO and affirmative action employer of veterans/individuals with disabilities. Accenture is committed to providing veteran employment opportunities to our service men and women. Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States. Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration. Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process. Further, at Accenture a criminal conviction history is not an absolute bar to employment. The company will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Additionally, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the company's legal duty to furnish information. 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