Senior Assistant Claims Examiner

Summary

Your role in our mission

Essential Job Functions

• Enters insurance claims received electronically or in written form.
• Answers incoming customer calls regarding claim processing. Documents claim and associated history.
• Evaluates available information to validate claims. Verifies policyholder information, policy effective dates, premium status and verification of claim eligibility.
• Sends claim form to claimant for updating, correction or completion.
• Investigates simple to moderately complex claims and determines level or resolution if appropriate; advises claimant of status; assists in negotiating settlement and resolution of claim.
• Identifies need for additional information; contacts appropriate source to obtain needed information. Verifies beneficiary or claimant information if claim is warranted. Identifies payment amount and obtains required management approvals for payment. Processes payment.

Basic Qualifications

• High school diploma or G.E.D.
• Fellowship of Life Health Claims (FLHC) Certification preferred
• Two or more years of auditing, accounting, contracts or information technology experience
• Experience working with insurance and/or medical terminology
• Experience working with appropriate claims processing procedures and documentation

Other Qualifications

• Good analytical and problem solving skills
• Good interpersonal skills to interact with team members
• Good communication skills to communicate with clients
• Good data entry skills
• Negotiation skills to interact with claimant
• Ability to keep sensitive and confidential material private
• Ability to work in a team environment

Work Environment

• Office environment

What we're looking for

What you should expect in this role

Competency1

Competency2

Competency3

Competency4

Competency5