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
- Paid Time Off starting at 160 hours annually for employees in their first year of service.
- Ten (10) paid holidays per year (typically mirroring the New York Stock Exchange (NYSE) holidays).
- Be Well Company holistic wellness program, which includes Wellness Coaching and Reward Dollars
- Parental Leave – fifteen (15) days of paid parental leave per calendar year to eligible employees with at least one year of service at the time of birth, placement of an adopted child, or placement of a foster care child.
- 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
