Claims Examiner
2 weeks ago
Position: Claims Examiner
Location: New York, NY (hybrid)
Compensation: $24-$27hr + OT
Fast growing insurance company seeks a Claims Examiner to join their Team
Responsibilities:
- Understand and appropriately apply department processes and regulatory policies.
- Manage new, continuous and/or periodic claims, by continually reviewing and prioritizing incoming mail and correspondence in order to ensure mandated turnaround times are achieved.
- Perform outreach to claimants, policy holders and health care providers via telephone and/or in writing to obtain information needed for initial and ongoing claim management.
- Conduct reviews of claimant, employer and medical information, as appropriate, along with other relevant information to accurately and timely determine benefit eligibility, claim duration and benefits payable (including the proper application of taxes).
- Escalate complex claim situations to Subject Matter Expert and/or Claims Supervisor
- Accurately and thoroughly document claim file actions and conversations.
- Achieve, and preferably exceed, ‘current’ departmental hourly/daily claim (task) output productivity goals.
- Make accurate determinations to approve, pend or deny claims consistent with department processes on all assigned claims
- Achieve, and preferably exceed, current departmental financial and statistical quality standards. Review, process, and respond to Quality Audits / Audit Correspondence.
- Promote a positive customer experience through prompt, accurate and courteous services to both internal and external customers.
Qualifications:
- College degree or an equivalent of at least three (3) years of work experience preferred.
- 1-2 years’ experience in a disability claims environment, preferred. State mandated disability a plus.
- Ability to calculate earnings, benefit levels, and FICA taxes
- Proficient in the use of Microsoft programs; Excel and Word
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