Claims Examiner

Job Description

Job Description

Claims Examiner

Overview

Perform claim processing for long term care (LTC) insurance claims and support the overall Long-Term Care Department. This work requires competent customer communication, evaluation of complex information, knowledge of insurance policies, and use of Long-Term Care Department operational procedure guides.

Job Details

Claims Examination- Obtain all necessary information such as diagnosis codes, admit & discharge dates, and charges for services. Review claims for missing information and/or errors based on claim forms received and corresponding documentation (i.e. invoices, care notes, etc). Enter data per policy guidelines.

Know Existing and Upcoming Insurance Policies- Study and learn policy requirements across different products and different States.

Know and Understand Claims Processes and Procedures – Review Standard Operating Procedures to ensure clear knowledge of correct claims processing, calculations, data entry and document retention.

Communicate Complex Insurance-Related Information- Make phone calls to facilities for clarification regarding claims submissions. Collaborate with coworkers and supervisors.

Report to and perform other work or projects as directed by the Claims Manager.

Job Requirements

Required

• Ability to research and logically consider details from many sources, and to bring them together to support a conclusion.
• Ability to accurately communicate in written format and verbally.
• Experience using mainframe computer and/or with PC applications such as MS Word or Outlook.
• High school diploma, GED, or any combination of education, professional training, or work experience that demonstrates ability to do the job.
• Decision making and problem solving.
• Sharp math aptitude with general accounting.
• Establish and maintain effective working relationships.
• Plan and organize work effectively.

Desired

• Previous Long Term Care (LTC) or other insurance claim processing experience.
• Knowledge of medical terminology and coding such as ICD-10 diagnosis codes.

BENEFITS:

• Medical Plans, including FSA and HSA
• Dental and Vision
• 401(k) (Roth and Traditional)
• Pet Insurance
• Parental Leave
• Paid Time and Sick Time off
• 10 Paid Holidays and 1 Birthday Pay
• Paid Volunteer Time
• College Tuition Reimbursement

At SILAC Insurance Company, our core values are not just a requirement, they are a standard by which

we live. These values are incorporated every day, whether we are discussing ideas for new projects and

procedures, finding a resolution for a customer's problem, or recruiting new talent. It is just one of the

many things that make SILAC Insurance Company a Top Workplace.

We celebrate a diverse and inclusive work environment, where we honor and support varying

backgrounds, beliefs, and perspectives for the benefit of our business, including our employees and

products. We are proud to be an equal-opportunity workplace and strive to be a place where every

employee feels they belong. We are committed to equal employment opportunity regardless of race,

color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status,

disability, gender identity, or Veteran status. If you have a disability or special need that requires

accommodation, please let us know.