Jobs in Port Elizabeth, África do Sul

Job Description

Claims Examiner I (Remote)

Primary Duties & Responsibilities

At Globe Life, we are committed to empowering our employees with the support and opportunities they need to succeed at every stage of their career. Our thriving and dynamic community offers ample room for professional development, increased earning potential, and a secure work environment.

We take pride in fostering a caring and innovative culture that enables us to collectively grow and overcome challenges in a connected, collaborative, and mutually respectful environment that calls us to help Make Tomorrow Better.

Role Overview

Could you be our next Claims Examiner I? Globe Life is looking for a Claims Examiner I to join the team!

In this role, you will be responsible for prompt and timely processing of supplemental accident and health claims accurately within deadlines, while following required department procedures and guidelines to ensure compliance with HIPAA, legal and insurance laws and regulations, and state specific policy and benefit contract provisions. Engage in phone correspondence with medical facilities, providers, policyholders, and agents, review medical records and various documentation to analyze and apply policy benefits, limitations and exclusions, provide phone support for the department's Call Center Unit, and assist with various department functions, projects, and assignments as directed

This is a remote / work from home position.

What You Will Do

• Prompt and daily processing of all health and accident claims by required deadlines which includes reviewing various claims documents, medical records, provider bills, receipts and invoices to apply or deny benefits.
• Ensuring claims are processed with accuracy and according to the company guidelines as required in the department’s policies and operating procedures, and in compliance with HIPAA, legal and insurance laws and regulations, and the state specific policy and benefit contract provisions.
• Contacting various medical facilities, providers, legal entities, policyholders and agents to obtain necessary documents required to process claims.
• Applying knowledge of underwriting health questions and medical terminology relating to policy form applications, waiting periods, and pre-existing conditions.
• Provide backup phone call support with prompt and timely answering of incoming phone calls and returning calls to customers and agents by accurately analyzing insurance contracts and state specific policy provisions, definitions, benefits, limitations, and exclusions for resolution.
• Efficiently and effectively review system memos and documents to thoroughly explain and provide details of the claims status, benefit payments, denials, appeal decisions, and required information needed for pended claims.
• Handle customer and agent inquiries, issues and complaints with timely research, follow up, and resolution in a professional and courteous manner.
• Ensure customer and agent needs are met on every interaction and documenting system memos and the claim file with all phone calls, issues, and correspondence.
• Meet quality assurance requirements and other key performance metrics and maintain productivity standards and performance.
• Cross training with other operational departments on functions that affect claims including premium deductions, multiple policy limits, cash value, return of premium, and money back maturity processes.
• Proper correspondence and communicating specific denial reasons to the policyholder in writing, creating special letters as needed, and completing authorization forms for new claims and medical records requests.
• Correcting and researching reasons for any claims processing errors received on a timely basis.
• Process and respond promptly to miscellaneous customer and agent requests, including mailing of claim forms, information release authorization testimonials, itemized benefits lists, faxes, and issuing of duplicate policies.
• Communicate pertinent information or problems promptly with the Team Leader, Supervisor and/or Manager.
• Determine and recommend areas of improvement for processes, procedures and system enhancements.
• Understand the processes in the Underwriting, Customer Service, Billing, and Corporate Services Departments
• Complete various training mandated by auditors, compliance and state requirements
• Assist with various department functions, miscellaneous projects and assignments as directed.
  
  

What You Can Bring

• High School Diploma or equivalent.
• Minimum of 3-5 years prior phone/customer service and office experience.
• Previous experience in a Claims service environment preferred.
• Medical terminology/medical office background desirable.
• Bilingual skills a plus.
• Must have a high level of quality focus on providing excellent customer service.
• Ability to process a high volume of claims efficiently and accurately.
• Critical problem solving, decision making, and analytical skills.
• Excellent verbal, communication, and written skills.
• Strong organizational and research skills.
• Must be detail oriented, have ability to work well under pressure, and handle multiple tasks with deadlines.
• Works well independently.
• Team player
  
  

Applicable To All Employees of Globe Life Family of Companies:

• Reliable and predictable attendance of your assigned shift.
• Ability to work full time and/or part time based on the position specifications.
  
  

How Globe Life Will Support You

Looking to continue your career in an environment that values your contribution and invests in your growth? We've curated a benefits package that helps to ensure that you don’t just work, but thrive at Globe Life:

• Competitive compensation designed to reflect your expertise and contribution.
• Comprehensive health, dental, and vision insurance plans because we believe that taking care of your well-being is fundamental to your performance.
• Robust life insurance benefits and retirement plans, including company-matched 401k and pension plan.
• Wellness club reimbursements and gym discounts to help you stay on top of your health.
• Paid holidays and time off to support a healthy work-life balance.
• Development training programs to enhance your skills and career progression and unlock your full potential.
  
  

Opportunity awaits! Invest in your professional legacy, realize your path, and see the direct impact you can make in a workplace that celebrates and harnesses your unique talents and perspectives to their fullest potential. At Globe Life, your voice matters.

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