Claims Specialist

1 week ago


Salt Lake, Utah, United States ManhattanLife Insurance & Annuity Company Full time
Job Title: Claims Specialist

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.
Requirements:
  • 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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