[Hiring] Claims Examiner Assistant @Gainwell Technologies LLC

Role Description

Your role in our mission includes the following essential job functions:

• Enters insurance claims received electronically or in written form.
• Answers incoming customer calls regarding claim processing and 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 of 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.

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.

Requirements

• 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 claimants.
• Ability to keep sensitive and confidential material private.
• Ability to work in a team environment.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Variety of leadership and technical development academies to help build your skills and capabilities.