Senior Claim Examiner

Company: Physicians Mutual® ( Learn More )

General Information
Not Specified
At least 3 year(s)
Job Description

Senior Claim Examiner

Physicians Mutual is hiring for a full time Senior Claim Examiner in our Claims Department. The selected candidate will evaluate and respond to claim service requests for customers, medical providers and entitled parties. Analyzes all claim information received in conjunction with contestable and incontestable Long Term Care. Other product knowledge, such as Disability, would be helpful.

The Senior Claim Examiner resolves claims in accordance with claim procedures, policy provisions and limitations, policy applications, underwriting guidelines, medical conditions, Company philosophy and state insurance laws. The candidate will correspond with the insured, doctors, hospitals, and other third parties to collect data. In addition, the Senior Claim Examiner will process payment or explain rejection decisions to customers through appropriate communication channels.

Job Qualifications:

  • Approximately 5 years of increasingly responsible auditing experience in Long Term Care, Disability, or Health Insurance required.
  • Excellent written and verbal communication skills.
  • Knowledge of medical conditions and relationship between etiology, symptoms and complicated and related health care procedures.
  • Process sophisticated problem solving, decision making, and organizational skills.
  • Ability to function effectively in a production environment.
  • Associate Degree and/or industry coursework is helpful for this position.
  • Job RequirementsAssistant Sales Manager preferences and requirements:College degree preferred. Minimum four to five years experience as insurance agent required. Prefer previous management experience RHU, CLU, LUTCF, ChFC or similar designation is preferred. Approximately 3 to 4 years on the job is required to gain full job responsibility.JOB QUALIFICATIONS (Knowledge, Skills, Abilities, and Personal Characteristics):Knowledge of interviewing guidelines, contracting, EEO and labor relations laws & guidelines.Knowledge of accounting & bookkeeping practices including audit procedures and budgetary constraints.Knowledge of Agency, Underwriting, Accounting, Employee Relations & Development and Claims Departments' procedures and functions.Extensive knowledge of Company products, sales strategies and State and Federal compliance laws.Strong written/verbal communication skills and strong human relation skills to resolve delicate situations.Ability to provide work direction and evaluate performance of subordinates.Knowledge of training procedures and guidelines and ability to effectively train agents.Knowledge of Company procedures and policies, including Region and Division Office guidelines.Ability to operate PC and utilize software programs such as Internet Navigation, Illustration Software, Microsoft Word, Excel, etc.