Claims Examiner II

21 hours ago

San Antonio, Texas, United States 052 SLIC Insurance Agency, LLC Full time
Job Summary

052 SLIC Insurance Agency, LLC is seeking a skilled Claims Examiner II to join our team. As a Claims Examiner II, you will be responsible for reviewing and evaluating incoming claims for payment or denial, and acting as a liaison for the carrier and the financial institution.

Key Responsibilities
  • Claims Adjudication: Adjudicate routine to moderately complicated Payment Protection claims and determine if benefits are payable or not, ensuring claims are adjudicated within the customer service level standards established by the company with adherence to Prompt Payment of Claims Regulation respective to each state.
  • Claimant Communication: Prepare letters and requests any information needed to make a determination on claims from insurance carrier, family, claimant, physicians, employers, and others. Submit all claims determined contestable to carriers for review and final determination.
  • Benefit Calculation: Calculate the benefit amount and ensure claims are not being overpaid or underpaid according to the provisions within the specific insurance certificate/policy form that describes the terms and conditions of the applicable coverage.
  • Claimant Support: Assist claimants or financial institutions via phone to answer questions, and document such within the claim file.
  • Carrier Management: Maintain carrier guidance and administrative files, required logs to comply with carrier requirements, reviews and evaluates instructions provided by carriers and assists management with proper implementation.
  • Administrative Tasks: Complete request for refund form and submit to Premium Processing; verify monthly outstanding loan balances for active and inactive financial institutions; and ensure that open accounts loan balances are verified every 6 months and closed accounts are verified each month; provides back-up assistance to the claims processor position for establishment and set-up of new claims.
Requirements
  • Education: High School Diploma or equivalency.
  • Experience: Minimum one (1) year of claims processing or related experience.
  • Skills: Able to type at least 40 WPM accurately and know 10 key by touch. Working knowledge of word processing and spreadsheets preferably in Microsoft Word and Excel. Excellent organizational and interpersonal skills. Able to draft business letters. Able to read and understand medical records. Able to prioritize job duties and be detail oriented.
  • Physical Demands: Able to lift up to 10-20 lbs. of claim storage boxes. Able to move (push/pull) up to 50 lbs. of files and documents. Able to bend, stoop, and stand to perform filing duties.
What We Offer
  • Competitive Compensation: Competitive overall compensation package.
  • Work-Life Balance: Work/Life balance.
  • Employee Engagement: Employee engagement activities and recognition awards.
  • Years of Service Awards: Years of Service awards.
  • Career Growth Opportunities: Career enhancement and growth opportunities.
  • Leadership Development: Leadership Academy and Mentor Program.
  • Continuing Education: Continuing education and career certifications.
  • Healthcare Benefits: Variety of healthcare coverage options.
  • Retirement Plan: Traditional and Roth 401(k) retirement plans.
  • Wellness Program: Lucrative Wellness Program.

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