Claims Examiner, Assistant (#25-05431)

About the role

Processes less complex or small standard claims to ensure accurate and timely completion.

Responsibilities

• 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 straightforward basic claims.
• Verifies policyholder information, policy effective dates, premium status and verification of claim eligibility.
• Sends claim form to claimant for updating, correction or completion.
• 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.
• Advises claimant of status and resolution of claim.
• Escalates claimant concerns as appropriate.

About The Company

Quant Dynamics Solutions is a consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.