Physicians Mutual’s Claims team is hiring a Senior Claim Examiner for their Long-Term Care team. This role evaluates and responds to claim service requests for Companies’ customers, medical providers and entitled parties.
Responsibilities Include :
- Analyzes all claim information received in conjunction with all company products which may include contestable and incontestable Hospital Indemnity, Cancer, LTC, ADB, Hospital Agency and Life products and riders.
- Resolves claims in accordance with claim procedures, policy provisions and limitations, policy application, underwriting guidelines, medical conditions, company philosophy and state insurance laws.
- Corresponds with insureds, doctors, hospitals, and other third parties to collect data. Processes payment or explains reject decisions to customers through appropriate communication channels.
- Confirms validity of contract between the company and Policyowner on Agency issued contracts, processes policy amendments or rescissions when necessary.
- Answers correspondence directed to Company President and inquiries from State Insurance Departments.
- This position requires continuing education and development of new auditing skills on additional product lines as business needs dictate.
Qualifications :
- Associate Degree or industry coursework is helpful to be successful in this position.
- Approximately 5 years of increasingly responsible auditing experience in Long Term Care, Disability, or Health Insurance is preferred but not required.
- Strong written and verbal communication skills are necessary to effectively correspond with Policyowners and other interested parties.
Ability to handle complex claim situations. This position does about 60% of their work day communicating with policy holders.
- Must possess sophisticated problem solving, decision-making, and organizational skills.
- Ability to function effectively in a production environment with high quality work.
- Good working knowledge of the function of other departments and their relationship to the claims process.
Senior Claim Examiner
Physicians Mutual’s Claims team is hiring a Senior Claim Examiner for their Long-Term Care team. Resolves claims in accordance with claim procedures, policy provisions and limitations, policy application, underwriting guidelines, medical conditions, company philosophy and state insurance laws. This ...
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