Life & DI Claims Examiner I
Renaissance Life & Health is seeking an experienced Life & Disability Claims Examiner to join our team
Job Description
Review submitted claims to ensure proper guidelines have been followed and eligibility requirements have been met. Contact group policyholders, beneficiaries or other third parties for missing information.
Consult with other professionals, such as management, senior team members, and other available resources, on complex claims.
Communicates with the claimants and employers to set expectations regarding return to work or claim status and next steps. Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence. Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system.
Determines benefits due, makes timely claims determinations, payments/approvals and adjustments.
Investigate claims. Search database to obtain background information and interview claimants and witnesses. Consult police, hospital records and policy files to verify information reported in a claim.
Calculate and authorize the appropriate payment for claim or refer to manager for additional review.
Assist in handling claims with suspected fraudulent or criminal activity. Access personal information and past claims histories to establish whether a claimant has ever attempted insurance fraud.
Answer verbal and written inquires and customer service queued calls on Group claims from insureds, group policy holders, agents, physicians, hospital attorneys, Workers' Compensation Board, Workers' Compensation carriers, State agencies, other insurance carriers, TPA's, Reinsurers and internal staff.
Respond to requests for information or return calls within established service guidelines.
Adheres to determined quality standards for the handling of calls and written inquiries. Other duties and responsibilities as needed or assigned.
Minimum Requirements
Associates Degree in Business preferred
2-4 years of related industry experience preferred
Disability and/or life insurance claims administration experience strongly preferred
Knowledge of ERISA regulations, statutory disability claims administration, required offsets and deductions, disability duration and medical management practices and Social Security application procedures strongly preferred
Basic proficiency in Microsoft Word/Office Suite required
Intermediate proficiency in Microsoft Excel required
Experience with claims management systems and electronic/paperless claims processing strongly preferred
Ability to perform work accurately and thoroughly
Ability to pay close attention to detail
Ability to prioritize and organize a heavy workload
Job Type: Full-time
Pay: $22.00 - $25.00 per hour
Benefits:
401(k)
401(k) matching
Dental insurance
Employee assistance program
Health insurance
Health savings account
Life insurance
Referral program
Vision insurance
Schedule:
8 hour shift
Monday to Friday
Education:
High school or equivalent (Required)
Experience:
claims: 2 years (Required)
short term disability: 1 year (Preferred)
Work Location: Remote
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