New Job Claims Examiner In Idaho
Claims Examiner |
Claims Examiner
Company : Gainwell Technologies
Salary : Details not provided
Location : Idaho
Full Description
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.
Basic Qualifications
- 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
Other Qualifications
- 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
Work Environment
- Office environment