Essential Job Functions
· Conducts correspondence related to client requests for information.
· Evaluates available information to validate claims. Verifies policyholder information, policy effective dates, premium status and verification of claim eligibility.
· 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.
· Investigates moderate to highly complex claims and determines level or resolution if appropriate; advises claimant of status; assists in negotiating settlement and resolution of claim.
· Receives demand letters; researches and investigates claims, responds within individual parameters and escalates as appropriate.
· High school diploma or G.E.D.
· Fellowship of Life Health Claims (FLHC) Certification preferred
· Four or more years of insurance/claims processing 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 negotiation skills to interact with claimant
· Ability to keep sensitive and confidential material private
· Ability to work in a team environment
· Office environment