Sr. Claims Examiner

Evaluate and analyze documentation for claim payments or denials according to the policy/certificate provisions and state regulations, with increased authority limits.

Requirements

• Analyze information/documentation received to determine how to proceed with a review of a claim and determine methods of obtaining additional information from alternative sources.
• Manage the review of a claim and outside sources used in the review.
• Document correspondence and conversations.
• Correspond verbally and in writing with claimants, medical providers, medical examiners, and law enforcement.
• Work closely with department manager, legal counsel, medical director, claims assistants, and other departments to gather information for contested claims.
• Monitor claims for fraud and proceed according to each situation, such as engaging the Fraud team or conducting additional research.
• Maintain compliance with regulations.
• May testify in depositions, hearings and trials; communicate the Company’s position regarding the claim.
• Assist peers with processing questions in the absence of higher level staff.
• May serve as a back up to review and authorize pending payments calculated by peers, within approval authority.

Benefits

• Competitive Pay
• Bonus for Eligible Employees
• Pension Plan
• 401k Match
• Employee Stock Purchase Plan
• Tuition Reimbursement
• Disability Insurance
• Medical Insurance
• Dental Insurance
• Vision Insurance
• Employee Discounts
• Career Training & Development Opportunities
• Health and Work/Life Balance Benefits
• Paid Time Off
• Ten paid holidays per year
• Be Well Company holistic wellness program
• Parental Leave
• Adoption Assistance
• Employee Assistance Program
• Back-Up Care Program
• PTO for Volunteer Hours
• Employee Matching Gifts Program
• Employee Resource Groups
• Inclusion and Diversity Programs
• Employee Recognition Program
• Referral Bonus Programs