Claims Examiner- Voluntary Benefits

The Voluntary Benefits Claims Examiner will support a large Group Insurance Business contract 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 the 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. Ability to read multiple pages of medical records to confirm benefits available to the member. Ability to apply plan provisions understand the needs of the clients. Expected to adhere to client Service Level Agreements and department s product s key performance requirements and any reporting. Able to utilize strong organizational skills to manage multiple priorities while working under tight time constraints, possess the ability to work through ambiguity, and work effectively with various vendors with strong interpersonal skills. Willing to support special internal functional projects and ad hoc requests as required. Able to work cohesively with Subject Matter experts to support the day to day tasks, able to anticipate, identify, and resolve complex issues problems. Able to communicate risks issues to supervisor and help with the resolution, as needed. Provide exceptional customer service either over the phone or through email. Able to provide leadership updates progress reports on training curriculum. Utilize tools independently and accurately to identify work to be completed. Professional and detailed verbal skills for 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 Detailed oriented with strong time management skills Job Requirement: Schedule flexibility to work a schedule from 7 am to 7 pm CST Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience. As required by local law, Accenture provides a reasonable range of compensation for roles that may be hired as set forth below. We anticipate this job posting will be posted until 08/28/2026. Accenture offers a market competitive suite of benefits including medical, dental, vision, life, and long-term disability coverage, a 401(k) plan, bonus opportunities, paid holidays, and paid time off. See more information on our benefits here: U.S. Employee Benefits | Accenture ( U.S. Employee Benefits | Accenture ( Role Location Hourly Salary Range California $21.68 to $40.53 Cleveland $20.10 to $32.40 Colorado $21.68 to $35.00 District of Columbia $23.13 to $37.26 Illinois $20.10 to $35.00 Maine $18.51 to $29.81 Maryland $21.68 to $35.00 Massachusetts $21.68 to $37.26 Minnesota $21.68 to $35.00 New York $20.10 to $40.53 New Jersey $23.13 to $40.53 Virginia $20.10 to $37.26 Washington $23.13 to $37.26 Requesting an Accommodation Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodations once hired. If you would like to be considered for employment opportunities with Accenture and have accommodation needs such as for a disability or religious observance, please call us toll free at View phone number on click.appcast.io or send us an email or speak with your recruiter. 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. For details, view a copy of the Accenture Equal Opportunity Statement ( Accenture is an EEO and Affiant employer of Veterans/Individuals with Disabilities. Accenture is committed to providing veteran employment opportunities to our service men and women. Other Employment Statements 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. California requires additional notifications for applicants and employees. If you are a California resident, live in or plan to work from Los Angeles County upon being hired for this position, please click here for additional important information. Please read Accenture’s Recruiting and Hiring Statement for more information on how we process your data during the Recruiting and Hiring process. #J-18808-Ljbffr Accenture