Medical Claims Examiner

4 weeks ago

Cincinnati, Ohio, United States Western & Southern Life Full time
Job Summary

Western & Southern Life is seeking a skilled Medical Claims Examiner to join our team. As a key member of our Benefits Department, you will be responsible for processing medical and flexible spending account claims in accordance with the provisions of multiple welfare plans.

Key Responsibilities
  • Process medical and flexible spending account claims of any type for multiple welfare plans according to established rules and guidelines.
  • Coordinate claims with Medicare and other group insurance carriers, ensuring compliance with rules established by Medicare and the National Association of Insurance Commissioners.
  • Approve claim payments up to $4,000 on personal authority, detecting and preventing potential fraudulent claims.
  • Maintain a working knowledge of medical terminology to interpret medical reports and bills, ensuring accurate adjudication of claims.
  • Determine proper payees for benefits, discharging the Company's liabilities in accordance with applicable laws and regulations.
  • Maintain compliance with federal and state laws related to privacy, security, confidentiality, and protection of personal information.
  • Perform other duties as assigned, including maintaining compliance with all policies and standards.

Requirements
  • High School Diploma or GED.
  • Proven experience in maintaining high accuracy with high volumes of work and/or multiple duties.
  • Demonstrated experience working effectively within a team, motivating co-workers in difficult situations.
  • Consistently meeting productivity and quality goals, with experience in identifying, defining, and resolving problems.
  • Strong attention to detail, excellent organizational skills, and ability to prioritize workload demands.
  • Excellent verbal and written communication skills, with ability to convey information to internal and external customers.
  • Proven ability to handle confidential information discreetly.
  • Working knowledge of word processing and spreadsheet applications.
  • Experience working independently to make decisions and demonstrate initiative.

Work Setting/Position Demands
  • Works in an office setting, remaining in a stationary position for long periods of time.
  • Requires ability to verbally communicate and exchange accurate information to customers and associates.
  • Requires visual acuity to read and interpret correspondence, procedures, reports, and forms.
  • Requires ability to prepare written correspondence, reports, and forms using prescribed formats.
  • Requires ability to apply principles of logical thinking to define problems and draw valid conclusions.
  • Performs substantial movement of wrists, hands, and fingers for continuous computer work.
  • Extended hours required during peak workloads or special projects/events.

Travel Requirements
  • None.

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