Health Claims Examiner I

Job Description
Health Claims Examiner I

Primary Duties & Responsibilities
At Globe Life, we are committed to empowering our employees with the support and opportunities they need to succeed at every stage of their career. Our thriving and dynamic community offers ample room for professional development, increased earning potential, and a secure work environment.

We take pride in fostering a caring and innovative culture that enables us to collectively grow and overcome challenges in a connected, collaborative, and mutually respectful environment that calls us to help Make Tomorrow Better.

Role Overview
Could you be our next
Health Claims Examiner I
?Globe Life is looking for a
Health Claims Examiner I
to join the team

In this role, you will be responsible for ensuring the timely and accurate adjudication of Cancer, Critical Illness, and Accident claims within federal regulatory guidelines and established organizational standards. The examiner will be expected to make appropriate claim determinations based on policy provisions and medical documentation.

This is a remote / work-from-home position.
What You Will Do

• Review pathology reports, medical narratives, HCFA-1500s, UB-04s, and other claim documents for completeness and validity to adjudicate claims within organizational guidelines and state/federal regulations.
• Determine covered services by reviewing contractual language.
• Interpret state and federal reimbursement allowable, along with their maximum limits.
• Request additional information needed to process claims from members and providers, as needed.
• Calculate benefits due and pay all covered claims within the designated authority limit.
• Convey adverse claim decisions resulting in denial through clear, concise, and well-constructed written correspondence.
• Meet and/or exceed established standards for productivity and quality.
• Concurrently access multiple databases, software programs, and/or online tools to perform required job functions.
• Attend and actively participate in departmental meetings, training sessions, and coaching sessions.
• Support and participate in all mandatory compliance training.
• Maintain patient privacy and confidentiality in accordance with HIPAA standards.
• Perform additional duties as assigned by management.

What You Can Bring

• Bachelor's degree from a four-year college or university preferred; or 1-2 years related experience and/or training; or equivalent combination of education and experience.
• Knowledge of the insurance industry and claims handling experience preferred.
• Billing / Coding experience is a plus.
• Knowledge of ICD-9/ICD-10, CPT coding, and medical terminology.
• Ability to compile and review information to make sound decisions.
• Skilled in performing intermediate arithmetic calculations.
• Excellent typing skills.
• Proficiency in Microsoft Office Suite (i.e., Outlook, Excel, Word) and other basic computer programs.
• Strong organizational skills and a detail-oriented approach to work.
• Excellent written and verbal communication skills.
• Ability to thrive in a fast-paced environment while working independently and with limited supervision.
• Positive team-oriented attitude with flexibility to adjust to changes as they arise.
• High technical aptitude with the ability to learn new systems quickly.

Applicable To All Employees of Globe Life Family of Companies:

• Reliable and predictable attendance of your assigned shift.
• Ability to work full time and/or part time based on the position specifications.

How Globe Life Will Support You
Looking to continue your career in an environment that values your contribution and invests in your growth? We've curated a benefits package that helps to ensure that you don't just work, but thrive at Globe Life:

• Competitive compensation designed to reflect your expertise and contribution.
• Comprehensive health, dental, and vision insurance plans because your well-being is fundamental to your performance.
• Robust life insurance benefits and retirement plans, including company-matched 401k and pension plan.
• Paid holidays and time off to support a healthy work-life balance.
• Parental leave to help our employees welcome their new additions.
• Subsidized all-in-one subscriptions to support your fitness, mindfulness, nutrition, and sleep goals.
• Company-paid counseling for assistance with mental health, stress management, and work-life balance.
• Continued education reimbursement eligibility and company-paid FLMI and ICA courses to grow your career.
• Discounted Texas Rangers tickets for a proud visit to Globe Life Field.

Opportunity awaits Invest in your professional legacy, realize your path, and see the direct impact you can make in a workplace that celebrates and harnesses your unique talents and perspectives to their fullest potential. At Globe Life, your voice matters.