Senior Claims Adjudicator - Policy Interpretations

Physicians Mutual Insurance Company, Inc.; Omaha (NE); Vor Ort; USD 65.000 - 90.000; Vollzeit

Zusammenfassung

Physicians Mutual Insurance Company, Inc. is seeking a Senior Claim Examiner in Omaha, NE to manage an assigned caseload through the lifecycle of claims.

The role requires reviewing, evaluating, and processing claims, and clearly communicating coverage determinations to policyholders, providers, and internal partners. The ideal candidate will have 2+ years of claims handling experience, strong written and verbal communication skills, and the ability to read, interpret, and apply insurance

Qualifikationen

• 2+ years of claims handling experience or related insurance industry experience preferred
• Strong written and verbal communication skills, including the ability to explain complex information clearly
• Ability to read, interpret, and apply insurance contract provisions when making claim decisions
• Proficiency in claims systems and standard business software
• Ability to manage an assigned caseload with accuracy and time management

Aufgaben

• Manage an assigned claims caseload on an ongoing basis, ensuring timely and accurate processing
• Review, analyze, and adjudicate claims according to policy provisions and company guidelines
• Communicate claim decisions, requirements, and next steps clearly via phone
• Handle complex or escalated claim situations with confidence and sound judgment
• Maintain consistent follow-up with policyholders, beneficiaries, providers, and internal departments
• Document all claim activity thoroughly and accurately in the claims management system
• Interpret policy language and explain coverage determinations in a clear, understandable manner
• Identify potential issues, discrepancies, or risks and elevate as appropriate
• Maintain compliance with regulatory requirements and internal quality standards
• Meet productivity, quality, and service level expectations

Kenntnisse

Claims handling experience

Communication skills

Contract interpretation

Attention to detail

Regulatory knowledge

Ausbildung

High school diploma

Associate or Bachelor's degree preferred

Tools

Claims systems

Jobbeschreibung

Physicians Mutual Insurance Company, Inc. is seeking a Senior Claim Examiner in Omaha, NE to manage an assigned caseload through the lifecycle of claims.

The role requires reviewing, evaluating, and processing claims, and clearly communicating coverage determinations to policyholders, providers, and internal partners. The ideal candidate will have 2+ years of claims handling experience, strong written and verbal communication skills, and the ability to read, interpret, and apply insurance