Claims Examiner

Job Title : Claims Examiner

Location : Philadelphia, PA 19106

Duration : 6 months

Position Type : Hourly contract Position (W2 only)

• Note : Job Schedule Hybrid Role 3 / 2 Schedule with 3 days in office-Monday / Wed / Thurs
• Job Hours-8 : 00am-6 : 00pm flexible-to be discussed with manager
• The standard work week is 40 hours per week (3 in office / 2 from home work week) and any overtime work has to be approved by the hiring manager in advance .

Job Description

Responsibilities

• Duties may include, but are not limited to : Accurately evaluate and process claims based on relevant documentation.
• Evaluate claim submissions, determine policy benefits, and request additional information as required to finalize claims.
• Manage inquiries, escalations, and pending files on claim decisions.
• Provide exceptional customer service by promptly following up and collaborating with internal and external business partners to address concerns and / or questions.
• Build broad knowledge of the various online systems for claims processing, imaging and policy administration.
• Maintain appropriate documentation on all claim files and manage caseload in a timely manner while meeting quality standards and SLAs.
• Research, analyze, and interpret policy language and state law as it relates to submitted claims.
• Communicate and collaborate effectively with Adjusters, Supervisors, and Managers to ensure service levels are met daily.
• Recognize, prioritize, and escalate service and claims issues according to escalation guidelines.
• Support an environment of continuous improvement by offering ideas and suggestions to improve workflows and processes.
• Performs other duties as assigned.

Skills 5 - 7 years of auditing Accident and Health Claims processing, AD&D claim processing or claim investigation experience preferred.

• Experience in a customer interfacing position with progressive responsibility in role.
• Experience with case management process and ability to implement case management processes with clients.
• Understanding and ability to effectively manage PPO networks to ensure cost savings measures.
• Strong communication and writing abilities.
• Ability to interact with senior management both internally and with our external business partners.
• Able to work under tight deadlines with limited oversight.

Education / Experience :

• Bachelor's degree or proven insurance related experience, Proven track record handling all types of Accident & Health claims.
• 5 - 7 years of auditing Accident and Health Claims processing, AD&D claim processing or claim investigation experience preferred.
• Ability to work independently and assimilate learning materials on many different subjects from various sources.
• Ability to deal with customers in a professional manner.
• Ability to self-motivate and self-start.
• Ability to make independent decisions using Client best practices for guidance.
• Ability to effectively work in a team environment.
• Ability to multi-task.
• Strong interpersonal, negotiation and customer service skills.
• Capable of dealing with highly visible and demanding customers.
• Highly organized and able to respond to insureds and internal and external business partners in a timely manner.
12 days ago