Job Description
6-12+ Month Contract Position
Location - Lombard, IL (3 days a week onsite)
Our client is looking to add a Supplemental Health Claims Examiner that will be responsible for analyzing, processing, and recommending approval or denial of Hospital Indemnity, Critical Illness/Specified Disease, Accident Insurance, Life product claims, and weekly income claims on various policies with a variety of related duties.
Job Responsibilities:
- Adjudicate 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.
- Proactively and efficiently obtain complete and accurate information from groups, agencies, physicians, beneficiaries, claimants, etc., to verify and ensure claim eligibility and resolve investigation issues.
- Maintain or exceed Department production, quality, and service level standards consistently.
- Provide professional, prompt, and accurate customer service via telephone and in writing to members, groups, doctors, etc., in handling various claim types.
- Assume responsibility for all assigned claims to review and resolve customer issues/problems and complaints promptly.
- Investigate, research, and verify information on all claim types to confirm eligibility and ensure sufficient/adequate information is obtained related to benefits being claimed.
- Maintains required levels of confidentiality.
- Provide effective verbal and written communication by involving appropriate parties within, or outside the department or company to professionally represent the company in all interactions.
- Maintain accurate documentation of activities and telephone conversations in claim file in accordance with company practices and procedures.
- Maintain thorough knowledge of all policies, statutes and regulations, medical conditions, and departmental procedures to ensure proper dispositions of claims.
- Recommend changes to management to avoid recurring customer inquiries/problems.
- Fully investigate all relevant claim issues, provide approvals, payments, or denials promptly and in full compliance with departmental procedures and Unfair Claims Practice regulations.
Required Job Qualifications:
- Associate’s or Bachelor’s degree or 0-2 years of equivalent business/related work experience.
- Good decision-making, problem solving and research skills with ability to analyze complex information.
- PC proficiency to include MS Word, Excel, SharePoint, and Outlook.
- Excellent customer service skills.
- Detail oriented with ability to maintain high level of quality and 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.
- Ability to fluently speak and write Spanish a plus.
The anticipated hourly rate range for this position is ($22-25/hr). Actual hourly rate will be based on a variety of factors including relevant experience, knowledge, skills and other factors permitted by law. A range of medical, dental, retirement and/or other benefits are available after a waiting period.