Claims Examiner
Responsibilities
- 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
Qualifications
- Associate’s degree in a business field or equivalent experience
- Excellent communication and customer service skills
- Organizational, problem-solving and analytical skills
- Ability to cross train and learn other products
- Ability to multi-task and adapt to change
Preferred Qualifications
- 2+ years of claims experience
- Strong organizational, problem solving, and analytical skills
- Flexible and adaptable to change
Working Conditions
- Office or hybrid office/remote environment
**Please note that the compensation information that follows is a good faith estimate for this position only and is provided pursuant to the Colorado Equal Pay for Equal Work Act and Equal Pay Transparency Rules and other compensation posting laws. It is estimated based on what a successful candidate might be paid in certain Company locations.**
Compensation:
The hourly for this position generally ranges between $16-$20 an hour. This range is an estimate, based on potential qualifications and operational needs. The range may vary above and below the stated amounts, as permitted by Colorado Equal Pay Transparency Rule 4.1.2 and other applicable local regulations.
Bonus Eligibility:
This position is also typically eligible for an Annual Bonus of 6% based on the Company Bonus Plan/Individual Performance and is at Company Discretion.