The Voluntary Benefits Claims Examiner will support a large Group Insurance Business contract is responsible for the calculation of Voluntary Benefits across limited products according to Plan Provisions.  Voluntary Benefits can include wellness, hospital indemnity, accident and critical illness products.  This position requires the knowledge and understanding of Voluntary Benefits policies and procedures with a medical terminology background and ability to read medical records outside of ICD’s, CPTs and HCPC to appropriately calculate the benefits due. You will be expected to follow through timely on claim processing, utilize judgment, and assess risk when rendering claim decisions. Able to communicate with various constituents with limited guidance and learn and transact using the client s systems. Expected to communicate clearly concisely to influence return to work, discuss terms of the certificate, and the basis of payment nonpayment.
Key Responsibilities:
Document all claim information including phone calls and correspondence.
Utilize effective communication to obtain information both verbally and in writing and provide information to the claimant and employer.
Ability to read multiple pages of medical records to confirm benefits available to the member.
Ability to apply plan provisions understand the needs of the clients.
Expected to adhere to client Service Level Agreements and department s product s key performance requirements and any reporting.
Able to utilize strong organizational skills to manage multiple priorities while working under tight time constraints, possess the ability to work through ambiguity, and work effectively with various vendors with strong interpersonal skills.
Willing to support special internal functional projects and ad hoc requests as required.
Able to work cohesively with Subject Matter experts to support the day to day tasks, able to anticipate, identify, and resolve complex issues problems.
Able to communicate risks issues to supervisor and help with the resolution, as needed.
Provide exceptional customer service either over the phone or through email.
Able to provide leadership updates progress reports on training curriculum.
Utilize tools independently and accurately to identify work to be completed.
Professional and detailed verbal skills for outbound calls to obtain medical records or claim details to gather data to work claim to completion.