Claims Specialist
1 week ago
ManhattanLife Insurance and Annuity Company is seeking a Claims Specialist to join our team in Utah. As a Claims Specialist, you will be responsible for evaluating medical claims submissions, processing claims on our systems, and ensuring data is up-to-date. You will also provide customer service to policyholders over the phone.
Key Responsibilities:- Review, reprice, and pay claims.
- Daily data entry of all claims for Medical, Home Health Care Prescription (HHC RX), Student Accident (SA), Cancer (CA), and Accident (AC) claims.
- Make customer service calls.
- Handle connections assigned.
- Follow up on all pending claims.
- Send out all claim forms related to Health, SA, CA, AC, HHC, HHC RX.
- Process returned mail.
- Send out explanation of benefits (EOB) to providers.
- Remain aware of any product system modifications and enhancements along with any procedural changes.
- Collaborate, coordinate, and communicate with departments within the company to ensure constant sharing of information and quality of service for our customers.
- Accurately determine claim benefits payable based on medical records, contract language, and any additional information needed to reach the appropriate decision in a timely manner.
- High School Graduate or equivalent (GED); one year of business experience; insurance knowledge preferred.
- Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
- Ability to make procedural decisions and judgements on sensitive, confidential issues.
- Ability to attentively take direction and execute tasks and changes from management for all processes and operations.
- Dependable and flexible.
- Computer literate; demonstrates proficiency in the use of Microsoft Word and Excel.
- Strong data and records management skills.
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