Claims Examiner

Calculated Hire; Alabama; Remote; USD 10,000 - 60,000; Full time

Job summary

Calculated Hire seeks an Associate Account Executive responsible for managing the claims process and determining benefit eligibility. This full-time position, based in Alabama, offers a competitive pay range of $18-19/hr and requires strong analytical and communication skills. Ideal candidates have prior experience in employee benefits claims and a detail-oriented approach to resolve complex claim situations efficiently.

Benefits

Medical insurance

Vision insurance

Qualifications

• 1-2 years in a group employee benefits claims environment preferred.
• Knowledge of medical terminology preferred.
• Ability to evaluate and process claims according to procedure.

Responsibilities

• Conduct reviews of claimant and employer information for determining eligibility.
• Manage the Group claims process and make accurate determinations.
• Promote a positive customer experience through courteous service.

Skills

Analytical skills

Written communication

Verbal communication

Problem-solving

Attention to detail

Education

College degree or equivalent work experience

Tools

Microsoft Excel

Microsoft Word

Job description

This range is provided by Calculated Hire. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$18.00/hr - $19.00/hr

Direct message the job poster from Calculated Hire

Associate Account Executive at CalculatedHire | Kelley School of Business Indianapolis Alum

Full Time, 6-month, likely extensions

$18-19/hr

Remote Position

Job Summary:

The incumbent is responsible for conducting reviews of claimant, employer and medical information, as appropriate, along with any other relevant information to accurately determine benefit eligibility, claim duration and benefits payable.

Duties/Responsibilities:

• Knowledge of and the accurate application of departmental processes consistent with ShelterPoint’s Group contract provisions.
• Manage the Group claims process by continually reviewing and prioritizing incoming mail and correspondence in order to render timely claim decisions across all lines of Group coverage.
• Perform outreach to claimants, planholders and health care providers via telephone and/or in writing to obtain information needed for claims administration/adjudication.
• Conduct reviews of claimant, employer and medical information, as appropriate, along with any other relevant information to accurately and timely determine benefit eligibility, claim duration and benefits payable.
• Partners with our corporate vendors (Davis, NVA, Change, etc.) and internal resources (i.e. AP/Finance) to ensure fulfillment of duties/responsibilities within established service levels.
• Escalate complex claim situations to SME and/or Claims Manager.
• Accurately and thoroughly document claim file actions and conversations.
• Make accurate determinations to approve, pend or deny claims consistent with department processes on all assigned claims.
• Records daily production and updates department head in accordance with measurable departmental standards (i.e. monthly KPIs).
• Achieve, and preferably exceed, ‘current’ departmental financial and statistical quality standards. Review, process and respond to Quality Audits / Audit Correspondence.
• Promote a positive customer experience through prompt, accurate and courteous service to both internal and external customers.
• Contributes to a positive work environment to ensure the achievement of departmental and corporate goals and objectives (other than Group claims examination).
• Contribute to department’s various project work and assignments, as needed.

Education and Experience:

• Represent the ShelterPoint brand with the utmost professionalism
• College degree or an equivalent of at least three (3) years of work experience preferred.
• 1-2 years in a group employee benefits claims environment preferred.
• Knowledge of medical terminology preferred
• Being Responsible and Reliable is a must
• Ability to evaluate and process claims according to procedure and practice
• Ability to adapt to change
• Ability to work independently, and as a team player, within a highly collaborative team environment
• Professional written and verbal communication and interpersonal skills
• Strong reading, writing and math skills required
• Independent problem-solving skills – ability to interpret and administer policy/plan provisions
• Ability to determine eligibility and calculate benefits payable
• Ability to gather, analyze and organize data to make educated decisions
• Ability to identify critical issues and exercise independent judgment
• Detail Oriented
• Proficient in the use of Microsoft programs; Excel and Word
• Knowledge of “WLT” system would be a plus

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Contract

Job function

• Job function

  Administrative and Analyst

• Industries

  Insurance and Insurance and Employee Benefit Funds

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Inferred from the description for this job

Medical insurance

Vision insurance

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