Medical Claims Examiner

1 week ago


Cincinnati, Ohio, United States Western & Southern Financial Group Full time

Welcome to Western & Southern Financial Group, where we strive to create value for our customers through meaningful and challenging work. Our focus on integrity, top-notch performance, collaboration, and teamwork drives our company forward.

With 135 years of operating history, we've built a reputation as a best company for career growth, ranked No. 29 among Fortune 500 companies. Our award-winning Talent Development Team helps us thrive and provide value to our customers, business partners, and associates.

We're committed to hiring and developing associates who are driven to excel, have a strong work ethic, and use astute, fact-based, and ethical judgment in decision-making.

A Day in the Life –

The Medical Claims Examiner processes medical and flexible spending account claims in accordance with the provisions of multiple welfare plans administered by the Benefits Department. This position approves claims involving payments up to $4,000. Utilizing Claim Facts System and Flexible Spending Account System to accomplish functions.

Duties and Responsibilities

  • Coordinates claims with Medicare and other group insurance carriers. Must have working knowledge of rules established by Medicare for coordination of benefits and rules established by the (NAIC) National Association of Insurance Commissioners for other group insurance.
  • Must be capable of detecting fraud or potential fraudulent claims.
  • Maintains a working knowledge of medical terminology to interpret medical reports and bills to properly adjudicate claims. Keeps abreast of new medical procedures and terminology.
  • Determines proper payees for benefits in order to discharge Company's liabilities.
  • Maintains compliance with applicable federal and state laws (e.g., HIPAA)

Benefits

  • Comprehensive benefits including medical, dental, vision, prescription, pet insurance, life insurance, disability, Fertility, maternity/caregiver & parental leave, and more
  • Retirement solution with our 401(k) savings AND pension plan
  • Paid time off that increases with tenure.
  • Tuition Reimbursement
  • Subsidized affordable parking
  • On-site Cafeteria and fitness center (including sports leagues)
  • On-site Registered Nurse
  • Career Coaching/Mentoring
  • Individualized development plans and career pathing


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