Senior Long-Term Care Claims Analyst

Physicians Mutual; Omaha (NE); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Dental insurance

Health insurance

Pet insurance

Job summary

Physicians Mutual in Omaha, NE is seeking an experienced Senior Claim Examiner to manage an assigned caseload and serve as the primary contact throughout the claim lifecycle. You will review, evaluate, and process claims while guiding policyholders, providers, and internal partners.

The ideal candidate has strong analytical and communication skills, can read and apply insurance contract provisions, and work accurately in a fast-paced setting with changing workloads.

Qualifications

• 2+ years of claims handling experience or related insurance industry experience.
• Strong knowledge of insurance policies, claims processes, and regulatory requirements.
• Ability to explain complex information clearly and manage sensitive conversations.

Responsibilities

• Manage an assigned claims caseload with timely and accurate processing.
• Review and adjudicate claims according to policy provisions and company guidelines.
• Communicate claim decisions and next steps clearly via phone.
• Handle escalated claim situations with sound judgment.
• Maintain thorough documentation in the claims system.
• Ensure compliance with regulatory requirements and quality standards.

Skills

Analytical skills

Written and verbal communication

Claims processing

Regulatory knowledge

Education

High school diploma

Associate or Bachelor’s degree preferred

Tools

Claims management system

Job description

Physicians Mutual in Omaha, NE is seeking an experienced Senior Claim Examiner to manage an assigned caseload and serve as the primary contact throughout the claim lifecycle. You will review, evaluate, and process claims while guiding policyholders, providers, and internal partners.

The ideal candidate has strong analytical and communication skills, can read and apply insurance contract provisions, and work accurately in a fast-paced setting with changing workloads.