Senior Claims Examiner (REMOTE)

Atlanta, GA - USA

Monthly Salary: Not Disclosed

Posted on: 6 hours ago

Vacancies: 1 Vacancy

Job Summary

Senior Claims Examiner

Remote

3 months contract (possible extensions)

Responsibilities

Review and assess supplemental health claims to determine eligibility based on policy terms and conditions.
Gather necessary documentation from claimants medical professionals and other relevant sources to support the claim evaluation process (quantitative review).
Analyze medical records employment history and other pertinent information to make informed decisions (qualitative review).
Communicate with claimants to provide updates on their claim status and request additional information when needed.
Collaborate with healthcare providers employers and other stakeholders to ensure accurate and timely processing of claims.
Maintain clear and professional communication with all parties involved in the claims process.
Ensure all claim-related documents are accurately recorded and stored in the workflow systems for future reference.
Prepare detailed reports and summaries of claims for internal review and decision-making purposes.
Maintain confidentiality and adhere to data protection regulations when handling sensitive information.
Ensure compliance with industry regulations company policies and legal requirements throughout the claims process.
Conduct regular audits of claims files to ensure accuracy completeness and adherence to standards.
Participate in training sessions to stay updated on changes in policies procedures and regulations.

Minimum Qualifications

High school diploma or equivalent
Claims operations experience for Group disability Employee Benefit Worker Compensation Claim Management Overpayment Recovery or Leave Management
6-18 months Life Insurance backend operations experience

Preferred Qualifications/ Skills

Strong English Communication (Both written & verbal)
Proactive communication
Multi-tasking ability
Time management
Attention to detail
Displays energy enthusiasm and flexibility in approaching the job
Must be able to work under pressure and meet deadlines while maintaining a positive attitude and providing exemplary customer service
Customer service focus
Basic Computer knowledge along with typing speed of 40 words/minute
Insurance knowledge

Senior Claims Examiner Remote 3 months contract (possible extensions) Responsibilities Review and assess supplemental health claims to determine eligibility based on policy terms and conditions. Gather necessary documentation from claimants medical professionals and other relevant sources to sup...