Hybrid Supplemental Health Claims Examiner

Job Description

Job Description

Hybrid Temp-to-Hire Supplemental Health Claims Examiner

Our client a busy and fast-growing Insurance Company is currently looking to fill a hybrid temp-to-hire, Supplemental Health Claims Associated position. You ideally must have at knowledge in one (1) of the following claim types: Critical Illness/Specified Disease/Specified Disease, Accidental Insurance, Hospital Indemnity or Short-Term Disability.  You must have a Bachelor’s Degree or four (4) years of equivalent business/related work experience equivalent work experience. There is expected to be some mandatory onsite training must be completed prior to working a remote work schedule .   A company laptop will be provided for work purposes only.  This is a temp-to-hire full-time position M-F from (8:00am to 4:30pm).

Job Responsibilities

·        Responsible for examining and processing all claim types including Accident Insurance, Critical Illness/Specified Disease, Hospital Indemnity Life product claims and weekly income claims in accordance with established policies and procedures.

·        Consistently adhere to the documented workflow guidelines and established procedures.

·        Calculate multiple benefits due based a combination of information on claim forms, medical information, plan certificates/contract and regulatory guidelines and administer provisions accurately, including, but not limited to, misrepresentation or pre-existing Investigation, Evidence of Insurability Review, Benefit Entitlement Review, Financial Accuracy, ERISA Guidelines, MAR Requirements, State Regulations, Company Financial Liability as applicable.

·        Obtain complete and accurate information from groups, agencies, physicians, beneficiaries, claimants, etc., to verify and ensure claim eligibility and resolve investigation issues.

·        Promotes a positive customer service image through prompt, accurate and courteous responses to customer information needs and resolve situations in accordance with SOP

·        Fully investigate all relevant claim issues, provide approvals, payments, or denials promptly and in full compliance w/departmental procedures and Unfair Claims Practice regulations.

Job Qualification Requirements

·          Bachelor’s degree or 4 years of equivalent business/related work experience.

·          Good decision-making, problem solving & research skills w/ ability to analyze complex info.

·           PC proficiency to include MS Word, Excel, SharePoint, and Outlook.

·           Excellent customer service skills.

·           Detail oriented/maintain high level of quality & accuracy in a fast-paced environment.

·           Clear and concise verbal and written communication skills.

·           Knowledge of medical terminology

Preferred Job Qualifications:

·        HIAA, LOMA or ICA courses a plus.

·        Aptitude for math and critical thinking skills.

·        Knowledge of state regulations, statutes, and ERISA.

·        Knowledge in any of the following core systems:  ECM, STAR (Claim System), Genelco/GIAS, Salesforce, UTS, Benefits Manager.

·        Knowledge in one (1) of the following claim types: Critical Illness/Specified Disease/Specified Disease, Accidental Insurance, Hospital Indemnity or Short-Term Disability.

·        Ability to fluently speak and write Spanish a plus.

If you, or anyone you know, is interested, qualified, and currently seeking employment please e-mail an updated resume to View email address on ziprecruiter.com for immediate review and consideration. 

We are employment specialists who have worked in heath care and managed care industry for over a total of 25 years. We staff temp, temp to hire, and direct hire placements

Company Description

We are employment specialists who have worked in heath care and managed care industry for over a total of 25 years. We staff temp, temp to hire, and direct hire placements