Claims Examiner Trainee

Illinois-Mutual; Peoria (IL); On-site; USD 48,000 - 49,000; Full time

Benefits offered by this job

Compressed 4 1/2-day work week

No monthly premium for medical, life &

Disability insurance coverage

Paid time-off with rollover

401(k) immediate vesting

On-site cafeteria

On-site exercise facility

Job summary

Illinois Mutual is seeking a Claims Examiner Trainee at its Home Office. Under supervision, you will learn to analyze claims to determine benefits due using established procedures and industry best practices, gathering information from policyowners, physicians and third parties to help ensure the appropriate decision is reached.

Responsibilities include reviewing cases, escalating complex claims, communicating decisions, ensuring timely payments, and maintaining documentation.

Qualifications

• Bachelor’s degree in Insurance, Risk Management, Business, Finance or related field.
• Demonstrate reliability, integrity and professionalism as well as a positive attitude.
• Must handle Protected Health Information and maintain confidentiality at all levels.
• Excellent problem-solving skills; able to respond to requests promptly and proactively.

Responsibilities

• Review an assigned caseload of claims and determine benefits due pursuant to the policy provisions within a designated authority level.
• Refer claim activity outside authority level to Senior Examiner or Supervisor.
• Discuss claims decisions regularly with Senior Examiner or Supervisor.
• Make timely claims payments through prompt and continual follow up of outstanding claim information as approved.
• Professionally and effectively communicate claim action with the claimant and all other appropriate parties, as directed.
• Properly escalate difficult or complex claims or claimant situations as necessary.
• Properly document all claim decisions through relevant information such as claim forms, medical records, independent medical exams and investigations.
• Accurately process payments through our information systems with the utmost attention to detail.
• Adhere to all claim rules, regulations and laws.
• Develop and maintain superior customer service to all of our customers, both internally and externally, through prompt and courteous service communication.

Skills

Reliability

Professionalism

Communication skills

Customer service

Attention to detail

Problem-solving

Time management

Bilingual Spanish

Teamwork

Education

Bachelor’s degree

Tools

Microsoft Office

Job description

Description

Job Title: Claims Examiner Trainee

Department: Claims
Reports To: Janelle Lewis
Location: Home Office
Job Type: Full Time

Commitment to Core Values

At Illinois Mutual, our culture is built around our four core values. These values shape how we operate and define our expectations of each team member’s contributions:

• Be honest, reliable and respectful
• Think of other first
• Work together to create results
• Stand out with personal, caring service

Job Summary

Under the direct guidance of a Supervisor or Senior Examiner, the Examiner Trainee learns to analyze claims to determine if benefits are due based on established procedures and industry best practices. As directed, the Examiner Trainee investigates claims through the gathering and processing of information from policyowners, physicians and third parties to help ensure the appropriate decision is reached.

Primary Responsibilities

• Review an assigned caseload of claims and determine benefits due pursuant to the policy provisions within a designated authority level
• Refer claim activity outside authority level to Senior Examiner or Supervisor
• Discuss claims decisions regularly with Senior Examiner or Supervisor
• Make timely claims payments through the prompt and continual follow up of outstanding claim information as approved
• Professionally and effectively communicate claim action with the claimant and all other appropriate parties, as directed
• Properly escalation difficult or complex claims or claimant situations as necessary
• Properly document all claim decisions through relevant information such as claim forms, medical records, independent medical exams and investigations
• Accurately process payments through our information systems with the utmost attention to detail
• Adhere to all claim rules, regulations and laws
• Develop and maintain superior customer service to all of our customers, both internally and externally, through prompt and courteous service communication
• Attend meetings and educational seminars or conferences for professional development as approved by management
• Learn about the insurance industry, the Company, its products, services, claims processing and the expectations of the position
• Develop skill base to apply discretion and sound judgment to various claims
• Assume additional responsibilities as necessary

Anticipated Salary: $47,500 - $49,000

Benefits Overview: We strive for our employees to feel appreciated and supported, both professionally and personally. Our comprehensive benefit and discount package that meets a variety of needs is one way we demonstrate this. Some of our most admired benefits include:

• Compressed 4 1/2-day work week (Half-Day Fridays)
• No monthly premium cost for employee medical, life and disability insurance coverage
• Paid time-off accrual, including annual rollover; and paid holidays
• Competitive 401(k) plan with immediate vesting on Company contributions
• Discounted on-site employee cafeteria
• On-site exercise facility and company-provided exercise time
• Tuition reimbursement and training incentives
• Access to voluntary dental and vision insurance coverage

Qualifications

• Bachelor’s degree* required – preferably in Insurance, Risk Management, Business, Accounting, Finance or other similar discipline.
• Demonstrate reliability, integrity and professionalism as well as a positive attitude
• Must handle Protected Health Information and maintain confidentiality at all levels
• Highly self-motivated, organized and attentive to details
• Effective communication skills, both verbal and written
• Excellent problem-solving skills; able to respond to requests promptly and proactively
• Comfortable in fast-paced environment; self-directed and flexible
• Ability to maintain professional and constructive working relationships with others as well as work independently
• Strong customer service and quality/accuracy focus
Proficiency of related information systems, including Microsoft Office programs (Word, Excel, Outlook)
• Bilingual (Spanish) proficiency a plus

Required Competencies (Proficiency Level)

• Accountability (1)
• Continuous Learning (1)
• Customer Focus (1)
• Integrity (1)
• Organizational Awareness (1)
• Teamwork (1)

This job description is intended to provide a general overview of the position and does not include every detail of the role. Responsibilities and expectations may be subject to change based on Company needs.

Illinois Mutual is an equal opportunity employer.