Supplemental Health Claims Examiner - Remote

Symetra has an exciting opportunity to join our growing team as a Supplemental Health Claims Examiner !

About the role

The Claims Examiner is responsible for accurate and timely adjudication of complex professional, facility, and ancillary claims. This role makes timely, accurate, and customer-focused claim decisions for supplemental health products that may include critical illness, hospital indemnity and scheduled or group accident claims. Proactively reach out to internal and external sources to gather relevant medical, financial, legal, and/or general data, compare it to the applicable contract and procedural documents, conduct an analysis, and engage peers and management as appropriate. Communicate verbally and in writing and fully leverage the claim system with accurate and comprehensive information. Maintain performance within departmental metrics.

What you will do

• Make timely, accurate, and customer-focused claim decisions.
• Reach out to obtain relevant information from multiple sources as needed on a claim-by-claim basis. This may include making contact with healthcare providers and claimants.
• Reviewing medical records, itemized bill, UB-04 or HCFA 1500, and adjudicating benefits for one claimant with multiple lines of coverage.
• Compare the information received to the terms, limitations, and conditions of the contract and applicable procedural documents and render the claim decision as quickly as possible.
• Document the claim systems in an accurate and comprehensive manner while maintaining maximum levels of efficiency.
• Prepare and disseminate articulate written and verbal communication to assorted internal and external sources. Prepare, update, and utilize a claim management plan to attain the most appropriate outcome.
• Remain in full compliance with ERISA, HIPAA, Fair Claim Settlement Practices Acts, and other statutory regulations.
• Demonstrate proficiency in supplemental health products and claim administration techniques. Remain fully compliant with operational standards. Meet or exceed claim team operational metrics.
• Maintain a superior level of genuine caring and empathetic customer service throughout all interactions. Anticipate customer needs and take action.
• Quickly resolve issues or concerns with payments, voids and refunds.
• Work as a team to support one another through flexibility, collaboration, creating a positive work environment, consistently maintaining professionalism and integrity, actively taking steps to foster high morale, and demonstrating a dedication to excellence.

Why work at Symetra

"I feel welcome and included at Symetra every day and I really believe you can be you at Symetra." - Megan H., Deputy Chief Compliance Officer

"I am grateful to be here and I know how blessed I am to work for a company that truly cares about me as a person". - Nancy R., Sr. Investment Fund Analyst

What we offer you

We don't take a "one-size-fits-all" approach when it comes to our employees. Our programs are designed to make your life better both at work and at home.

• Flexible full-time or hybrid telecommuting arrangements
• Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6%
• Paid time away including vacation and sick time, flex days and ten paid holidays
• Give back to your community and double your impact through our company matching
• Want more details? Check out our Symetra Benefits Overview

Compensation

Hourly Range: $22.38 - $37.32 plus eligibility for annual bonus programs

Who you are

• 1-3 years of cumulative, relevant experience
• Extensive knowledge of supplemental health products and the ability to interpret policy language for critical illness, hospital indemnity, and scheduled or group accident claims.
• Proficient in reviewing medical records, itemized bills, and standard claim forms such as the UB04 and HCFA 1500.
• Exercises initiative and independent judgment while working within established procedural guidelines.
• High school diploma required.

We empower inclusion
At Symetra, we aspire to be the most inclusive insurance company in the country. We're building a place where every employee feels valued, respected, and has opportunities to contribute.

Inclusion is about recognizing our assumptions, considering multiple perspective, and removing barriers. We accept and celebrate diverse experiences, identities, and perspectives, because lifting each other up fuels thought and builds a stronger, more innovative company. We invite you to learn more about our efforts here.

Creating a world where more people have access to financial freedom
Symetra is a national financial services company dedicated to helping people achieve their financial goals and feel confident about the future. In our daily work, we're guided by the principles of Value, Transparency and Sustainability. This means we provide products and services people need at a competitive price, we communicate clearly and openly so people understand what they're buying, and we design products--and operate our company--to stand the test of time. We're committed to showing up for our communities, lifting up our employees, and standing up for diversity, equity and inclusion (DEI). Join our team and help us create a world where more people have access to financial freedom.

For more information about our careers visit:

Work Authorization
Employer work visa sponsorship and support are not provided for this role. Applicants must be currently authorized to work in the United States at hire and must maintain authorization to work in the United States throughout their employment with our company.

Please review Symetra's Remote Network Minimum Requirements:

As a remote-first organization committed to providing a positive experience for both employees and customers, Symetra has the following standards for employees' internet connection:

• Minimum Internet Speed:100 Mbps download and 20 Mbps upload, in alignment with the FCC's definition of "broadband."
• Internet Type:Fiber, Cable (e.g., Comcast, Spectrum), or DSL.
• Not Permissible:Satellite (e.g., Starlink), cellular broadband (hotspot or otherwise), any other wireless technology, or wired dial-up.

When applying to jobs at Symetra you'll be asked to test your internet speed and confirm that your internet connection meets or exceeds Symetra's standard as outlined above.

Identity Verification

Symetra is committed to fair and secure hiring practices. For all roles, candidates will be required (after the initial phone screen) to be on video for all interviews. Symetra will take affirmative steps at key points in the process to verify that a candidate is not seeking employment fraudulently, e.g. through use of a false identity.

Failure to comply with verification procedures may result in:

• Disqualification from the recruitment process
• Withdrawal of a job offer
• Termination of employment and other criminal and/or civil remedies, if fraud is discovered

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