Junior Claims Examiner — Training Path

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

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.