Supplemental Health Claims Examiner - Remote

About the role

The Claims Examiner is responsible for accurate and timely adjudication of complex professional, facility, and ancillary claims. This role makes timely, accurate, and customer-focused claim decisions for supplemental health products that may include critical illness, hospital indemnity, and scheduled or group accident claims.

Responsibilities

• Make timely, accurate, and customer-focused claim decisions.
• Reach out to obtain relevant information from multiple sources as needed on a claim-by-claim basis. This may include making contact with healthcare providers and claimants.
• Reviewing medical records, itemized bills, UB-04 or HCFA 1500, and adjudicating benefits for one claimant with multiple lines of coverage.
• Comparing the information received to the terms, limitations, and conditions of the contract and applicable procedural documents and rendering the claim decision as quickly as possible.
• Documenting the claim systems in an accurate and comprehensive manner while maintaining maximum levels of efficiency.
• Preparing and disseminating articulate written and verbal communication to assorted internal and external sources.
• Preparing, updating, and utilizing a claim management plan to attain the most appropriate outcome.
• Maintaining performance within departmental metrics.

Requirements

• 1-3 years of cumulative, relevant experience.
• Extensive knowledge of supplemental health products and the ability to interpret policy language for critical illness, hospital indemnity, and scheduled or group accident claims.
• Proficient in reviewing medical records, itemized bills, and standard claim forms such as the UB-04 and HCFA 1500.
• Exercises initiative and independent judgment while working within established procedural guidelines.
• High school diploma required.

Qualifications

High school diploma required.

Skills

Claims administration techniques, proficiency in supplemental health products, interpreting policy language, reviewing medical records, itemized bills, and standard claim forms.

Benefits

Flexible full-time or hybrid telecommuting arrangements, 401(k) plan with immediate vesting and company matching up to 6%, paid time away including vacation and sick time, flex days, and ten paid holidays, giving back to the community and doubling the impact through company matching.

Pay

Hourly Range: $22.38 – $37.32 plus eligibility for annual bonus programs.

Schedule

Remote-first arrangement.

Who You Are

1-3 years of cumulative, relevant experience, extensive knowledge of supplemental health products, proficient in reviewing medical records, itemized bills, and standard claim forms, exercises initiative and independent judgment while working within established procedural guidelines, high school diploma required.