Associate Claims Examiner

This is a fully remote position, open to applicants in New York, +1 more state.

📋 Description

• Acquire expertise in managing all facets of assigned claims.

• Process claims for approval or denial based on policy terms and conditions.

• Receive and maintain relevant reports.

• Assist beneficiaries throughout the claims process.

• Submit claims for reinsurance.

• Deliver customer service to both internal and external clients.

• Evaluate submitted claims for compliance with guidelines and eligibility criteria.

• Reach out to policyholders, beneficiaries, or third parties for any missing information.

• Engage in scheduled queue call management and dedicated client phone calls.

• Address basic inquiries and clarify claims requirements and decisions.

• Process designated claims using claims processing systems.

• Create claim files and input claims data and payments into the relevant systems.

• Manage and distribute both paper and electronic mail and faxes.

• Prepare claims documentation for imaging and accurately maintain statutory files.

• Follow up on outstanding requirements and adhere to regulatory and state mandates.

• Distribute claim documents to designated claim examiners.

• Support claims account reconciliation and provide backup assistance.

• Claims Examiner: investigate claims, interview claimants and witnesses, and verify information using police, hospital, and policy records.

• Claims Examiner: consult with lawyers and physicians on complex claims.

• Claims Examiner: assist with suspected fraudulent or criminal activities.

• Respond to inquiries from insured individuals, policyholders, agents, physicians, hospitals, attorneys, regulators, carriers, reinsurers, and internal teams.

• Analyze claim reports and take action on prioritized cases.

• Organize incoming claims and process daily mail within established standards.

• Complete follow-ups and resolve claims within state, federal, and internal timelines.

⛳️ Requirements

• An Associate’s degree in business is required; a degree in a related field is also acceptable.

• Associate Claims Examiner: 2–3 years of relevant experience is required.

• Associate Claims Examiner: 1–2 years of experience in life insurance is required.

• Experience in a customer service or insurance industry setting is necessary.

• Intermediate proficiency in Microsoft Excel is required.

• Basic knowledge of Microsoft Word is required.

• Claims Examiner: 3–5 years of related experience are required.

• Claims Examiner: 3–5 years of experience in life insurance is necessary.

• Claims Examiner: Administrative experience is required.

• Familiarity with medical terminology and company products is strongly preferred.

• Industry-recognized certifications are preferred.

• Experience with Sigma, E-Records, Life Support Plus, Freedom, and Lotus Notes is strongly preferred.

• Visa sponsorship is not available for this position.

🏝️ Benefits

• Competitive salary and benefits package.

• Telecommuting flexibility may be available.

• Relocation assistance is not provided.

• Visa sponsorship is not available.