Critical Illness Claims Representative
TALENT Software Services
Job Description
Job Description
Title: Critical Illness Claims Rep
Duration: 6 months
Location: Minneapolis, MN. (2 days/week) - Contract to Perm for the right candidate.
Hybrid expectations into Minneapolis, MN. (2 days/week). Enjoy the vibrant city life of Minneapolis, known for its cultural landmarks and beautiful parks, while working in a dynamic and supportive environment.
Responsible for interpreting contract language and processing claims with high complexity. Provide a high quality of service with minimal direction, that is consistent with regulatory and compliance requirements.
Description:
- Analyze and determine Critical Illness claim processing in an accurate and timely manner, to include payment, denial, and requests for additional information.
- Create and maintain excellent working relationships and communication with internal and external customers.
- Actively participates in root cause problem-solving activities in a team environment.
- Manage work queue assignments within agreed SLAs, and support others in the same.
- Ability to handle complex claims including communicating with customers by phone and providing empathy and de-escalating measures for sensitive issues.
- Other duties and projects as assigned.
Knowledge & Experience:
- Experience with Voluntary Critical Illness Insurance benefits preferred with complex medical review experience.
- Strong ability to decipher medical terminology and documentation to connect with Policy definitions to determine if all conditions of the benefit are met.
- Interpret diagnoses and clinical evidence within medical records to determine when an individual was diagnosed with their condition(s).
- Reduce risk through attention to detail to maintain compliance guidelines and ensure decisions are fully supported by documentation and policy language.
- Strong written and oral communication capabilities to provide clear, policy-based denial letters to our customers.
- Understand Standards of Work and job aids.
- Advanced technical proficiency with claims processing systems and the ability to navigate multiple systems concurrently to research, validate, and adjudicate claims efficiently.
- Strong working knowledge of Microsoft Office applications (Excel, Word, Outlook).
- Proven critical thinking and problem solving.
- Capacity to prioritize and balance workloads in a workflow environment.
- Ability to collaborate with others, to include across departments, to solution for shared customers.
Our client is a leading global technology company known for developing innovative cloud, productivity, AI, and enterprise solutions that help individuals and organizations achieve more.
Company Description
Our client is a leading global technology company known for developing innovative cloud, productivity, AI, and enterprise solutions that help individuals and organizations achieve more.
Vacancy posted 7 days ago
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