Voluntary Benefits Claims Examiner

Accenture; Houston (TX); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading global consulting firm is seeking a Voluntary Benefits Claims Examiner in Houston, Texas. This role will support a large Group Insurance Business contract, with responsibilities including claim processing and customer communication. Ideal candidates will have experience in medical insurance claims and a strong understanding of medical terminology. The position requires strong communication and organizational skills, with a flexible schedule from 7 am to 7 pm CST.

Qualifications

• Minimum of 6 months experience in Medical Insurance Claims Processing.
• Minimum of 1 year experience in a contact center or call center.
• Ability to read multiple pages of medical records.

Responsibilities

• Document all claim information including phone calls.
• Provide exceptional customer service over the phone or via email.
• Communicate with clients effectively to obtain and share information.

Skills

Communication

Organizational skills

Medical terminology knowledge

Mathematical skills

Education

Bachelor’s Degree

Tools

Microsoft Excel

Microsoft Word

Job description

Overview

The Voluntary Benefits Claims Examiner will support a large Group Insurance Business contract and is responsible for the calculation of Voluntary Benefits across limited products according to Plan Provisions. Voluntary Benefits can include wellness, hospital indemnity, accident and critical illness products. This position requires knowledge and understanding of Voluntary Benefits policies and procedures with a medical terminology background and the ability to read medical records outside of ICDs, CPTs and HCPC to appropriately calculate the benefits due. You will be expected to follow through timely on claim processing, utilize judgment, and assess risk when rendering claim decisions. Able to communicate with various constituents with limited guidance and learn and transact using the client’s systems. Expected to communicate clearly and concisely to influence return to work, discuss terms of the certificate, and the basis of payment nonpayment.

Key Responsibilities

• Document all claim information including phone calls and correspondence.
• Utilize effective communication to obtain information both verbally and in writing and provide information to the claimant and employer.
• Ability to read multiple pages of medical records to confirm benefits available to the member.
• Ability to read and apply plan provisions; understand the needs of the clients.
• Adhere to client Service Level Agreements and department product key performance requirements and any reporting.
• Utilize strong organizational skills to manage multiple priorities while working under tight time constraints, handle ambiguity, and work effectively with various vendors with strong interpersonal skills.
• Support special internal functional projects and ad hoc requests as required.
• Work cohesively with Subject Matter Experts to support day-to-day tasks, anticipate, identify, and resolve complex issues and problems.
• Communicate risks and issues to supervisor and help with resolution, as needed.
• Provide exceptional customer service over the phone or through email.
• Provide leadership updates and progress reports on training curriculum.
• Utilize tools independently and accurately to identify work to be completed.
• Engage in professional and detailed verbal activities for outbound calls to obtain medical records or claim details to gather data to work claim to completion.

Basic Qualifications

• Minimum of 6 months experience in Medical Insurance Claims Processing
• Minimum of 1 year experience in a contact center/call center

Preferred Qualifications

• Group Life/Disability/Voluntary Claims experience
• Bachelor’s Degree
• NY Adjustor License
• Strong mathematical skills

Professional Skills

• Proficiency in Windows environment, including Word and Excel
• Medical terminology knowledge
• Strong written and verbal communications required
• Detail oriented with strong time management skills

Job Requirement: Schedule flexibility to work a schedule from 7 am to 7 pm CST.

Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience. As required by local law, Accenture provides a reasonable range of compensation for roles that may be hired in California, Colorado, District of Columbia, Illinois, Maryland, Minnesota, New Jersey, New York or Washington as set forth below. We accept applications on an on-going basis and there is no fixed deadline to apply.

Information on benefits is here. (https://www.accenture.com/us-en/careers/local/total-rewards)

Role Location Hourly Salary Range

California $19.71 to $38.51

Colorado $19.71 to $33.27

District of Columbia $21.01 to $35.43

Illinois $18.27 to $33.27

Minnesota $19.71 to $33.27

Maryland $19.71 to $33.27

New York/New Jersey $18.27 to $38.51

Washington $21.01 to $35.43

Requesting an Accommodation

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