Evaluates and analyzes documentation thoroughly to determine claim processing according to policy/certificate provisions and state regulations with limited authority limits
Analyzes any additional information/documentation received to determine how to proceed with a review of a claim under supervision and determines methods of obtaining information from alternative sources.
Manages the review of a claim and the outside sources used in the review.
Thoroughly documents correspondence and conversations.
Corresponds verbally and in writing with claimants, medical providers, medical examiners, and law enforcement.
Works closely with manager claims examiner, legal counsel, medical director, claims assistants, and other departments.
Monitors claims for fraud and proceeds accordingly
Infrequently testifies in depositions, hearings and trials; communicates the Company's position regarding the claim
Maintains compliance with regulations and respond to any insurance department complaints
Bachelors degree or equivalent work experience required
Up to 2 years experience in claims
Quickly learn product language and provisions
Strong communication skills-verbal and written
Proven organizational abilities
Ability and initiative to perform with moderate supervision