Job Description : Summary
Processes moderately complex claims to ensure accurate and timely completion. Assists in negotiating claims settlements.
Essential Job Functions
Enters insurance claims received electronically or in written form.
Answers incoming customer calls regarding claim processing. Documents claim and associated history.
Evaluates available information to validate claims. Verifies policyholder information, policy effective dates, premium status and verification of claim eligibility.
Sends claim form to claimant for updating, correction or completion.
Investigates simple to moderately complex claims and determines level or resolution if appropriate; advises claimant of status;
assists in negotiating settlement and resolution of claim.
Identifies need for additional information; contacts appropriate source to obtain needed information. Verifies beneficiary or claimant information if claim is warranted.
Identifies payment amount and obtains required management approvals for payment. Processes payment.
High school diploma or G.E.D.
Fellowship of Life Health Claims (FLHC) Certification preferred
Two or more years of auditing, accounting, contracts or information technology experience
Experience working with insurance and / or medical terminology
Experience working with appropriate claims processing procedures and documentation
Good analytical and problem solving skills
Good interpersonal skills to interact with team members
Good communication skills to communicate with clients
Good data entry skills
Negotiation skills to interact with claimant
Ability to keep sensitive and confidential material private
Ability to work in a team environment