Claims Examiner- Voluntary Benefits

About the role

The Voluntary Benefits Claims Examiner supports a large Group Insurance Business contract and is responsible for calculating Voluntary Benefits across limited products according to Plan Provisions. Voluntary Benefits can include wellness, hospital indemnity, accident and critical illness products. This position requires knowledge and understanding of Voluntary Benefits policies and procedures with a medical terminology background and the ability to read medical records outside of ICD’s, CPTs, and HCPCS to appropriately calculate the benefits due.

Responsibilities

• Document all claim information including phone calls and correspondence.
• Utilize effective communication to obtain information both verbally and in writing and provide information to the claimant and employer.
• Able to read multiple pages of medical records to confirm benefits available to the member.
• Able to apply plan provisions and understand the needs of the clients.
• Adhere to client Service Level Agreements and department’s product’s key performance requirements and any reporting.
• Able to utilize strong organizational skills to manage multiple priorities while working under tight time constraints, possess the ability to work through ambiguity, and work effectively with various vendors with strong interpersonal skills.
• Willing to support special internal functional projects and ad hoc requests as required.
• Able to work cohesively with Subject Matter experts to support the day-to-day tasks, able to anticipate, identify, and resolve complex issues/problems.
• Able to communicate risks/issues to supervisor and help with the resolution, as needed.
• Provide exceptional customer service either over the phone or through email.
• Able to provide leadership updates progress reports on training curriculum.
• Utilize tools independently and accurately to identify work to be completed.
• Professional and detailed verbal skills for outbound calls to obtain medical records or claim details to gather data to work claim to completion.

Qualifications

• Minimum of 6 months experience in Medical Insurance Claims Processing.
• Minimum of 1 year experience in a contact center/call center.
• Preferred qualifications include Group Life/Disability/Voluntary Claims experience, Bachelor’s Degree, NY Adjustor License, Strong mathematical skills, Professional Skills, Proficiency in Windows environment, including Word and Excel, Medical terminology knowledge, Strong written and verbal communications, Detailed oriented with strong time management skills.

Pay

Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience. As required by local law, Accenture provides a reasonable range of compensation for roles that may be hired as set forth below.

Schedule

Schedule flexibility to work a schedule from 7 am to 7 pm CST.

Benefits

See more information on our benefits here.

Requesting an Accommodation

If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process.

Equal Employment Opportunity

We believe that no one should be discriminated against because of their differences. All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.