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We are seeking a dedicated Claims Case Manager to provide comprehensive claim servicing to our insurance policyholders. This role involves managing the entire claims process from intake to final decision, ensuring frequent status updates to claimants through their preferred communication channels (email, phone, mail, etc.). The ideal candidate will have a strong analytical skill set, a thorough understanding of the claims process, and the ability to communicate with empathy and detail.
Job Responsibility:
End-to-End Claim Management: Handle every aspect of the claim process, from intake to final decision
Status Updates: Provide frequent updates to claimants through their preferred communication channels
Document Review: Thoroughly review medical documents, claim forms, and policy notes
Communication: Interact with claimants with empathy and attention to detail
Team Collaboration: Work with team members to ensure high-quality service and resolution of issues
Record Keeping: Maintain accurate records and reports throughout the claims process
Data Analysis: Compile and analyze data to identify trends and perform root cause analysis
Claim Initiation: Gather information and initiate claims through various channels
Detailed Logging: Log and update pertinent information throughout the claim lifecycle
Omni-Channel Correspondence: Communicate required medical records and claim information via email, mail, and phone
Proactive Follow-Up: Follow up on pending claims and assist in gathering required medical records
Benefit Calculation: Calculate benefit amounts and process payments through the claims system
Multitasking: Manage a caseload of active claims and perform end-to-end steps
Attention to Detail: Ensure accuracy and organization in logging, tracking, and reviewing claims. Identify and flag potential fraudulent activities
Collaboration: Work with management and team members to address service issues and concerns
Empathy: Communicate with claimants with empathy and a willingness to help
Requirements:
2 years in an analytical role reviewing medical benefits and claims
2 years of claims adjudication experience, preferably in life, and supplemental products (e.g., critical illnesses such as cancer, stroke, heart attack, kidney disease)
4 years of experience reviewing and assessing medical records
Experience articulating claim requirements clearly and concisely
Minimum high school diploma or GED
At least 1 year of experience working from home with proven productivity and quality
Designated quiet area for completing calls
Must Pass Drug screen
Must Pass a background check with Education check and employment verification check
Nice to have:
college degree
Any state specific certification related to performing the job duties
What we offer:
medical insurance with an employer contribution
dental insurance with an employer contribution
vision insurance with an employer contribution
flexible spending or health savings account
life and AD&D insurance
short- and long-term disability coverage
paid time off
employee assistance
participation in a 401k program with company match