Senior Claims Examiner - REMOTE

Senior Claims Examiner

Remote

3 months contract (possible extensions)

Responsibilities

• Review and assess supplemental health claims to determine eligibility based on policy terms and conditions.
• Gather necessary documentation from claimants, medical professionals, and other relevant sources to support the claim evaluation process (quantitative review).
• Analyze medical records, employment history, and other pertinent information to make informed decisions (qualitative review).
• Communicate with claimants to provide updates on their claim status and request additional information when needed.
• Collaborate with healthcare providers, employers, and other stakeholders to ensure accurate and timely processing of claims.
• Maintain clear and professional communication with all parties involved in the claims process.
• Ensure all claim-related documents are accurately recorded and stored in the workflow systems for future reference.
• Prepare detailed reports and summaries of claims for internal review and decision-making purposes.
• Maintain confidentiality and adhere to data protection regulations when handling sensitive information.
• Ensure compliance with industry regulations, company policies, and legal requirements throughout the claims process.
• Conduct regular audits of claims files to ensure accuracy, completeness, and adherence to standards.
• Participate in training sessions to stay updated on changes in policies, procedures, and regulations.

Minimum Qualifications

• High school diploma or equivalent
• Claims operations experience for Group disability, Employee Benefit, Worker Compensation, Claim Management, Overpayment Recovery, or Leave Management
• 6-18 months Life Insurance backend operations experience

Preferred Qualifications/ Skills

• Strong English Communication (Both written & verbal)
• Proactive communication
• Multi-tasking ability
• Time management
• Attention to detail
• Displays energy, enthusiasm, and flexibility in approaching the job
• Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
• Customer service focus
• Basic Computer knowledge along with typing speed of 40 words/minute
• Insurance knowledge