· Job Description:
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
· Office environment