Claims Examiner

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

📋 Description

• Acquire expertise in managing all elements of the claims process for assigned cases.

• Gain knowledge in processing claims, receiving and maintaining reports, assisting beneficiaries throughout the claims process, filing for reinsurance, and delivering customer service.

• Assess and process disability claims for approval or denial in accordance with policy terms and conditions.

• Review submitted claims to ensure compliance with guidelines and eligibility criteria.

• Reach out to policyholders, beneficiaries, and third parties to obtain missing information.

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

• Address basic inquiries and assist callers in understanding claims requirements and decisions.

• Process assigned claims using claims processing systems.

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

• Handle and distribute paper and electronic mail as well as faxes.

• Prepare claims documents for imaging and maintain comprehensive, accurate statutory files.

• Follow up on outstanding requirements and disseminate claim documents.

• Assist with claims account reconciliation and provide backup support.

• Deliver customer service and maintain professional communication with both internal and external customers.

• Investigate claims by searching databases, interviewing claimants and witnesses, and consulting records and professionals.

• Assist with claims that involve suspected fraudulent or criminal activities.

• Address inquiries from insured individuals, policyholders, agents, physicians, hospitals, attorneys, agencies, carriers, reinsurers, and internal staff.

• Analyze claim reports and take necessary actions accordingly.

• Set up incoming claims and process daily mail within the required timeframes.

• Complete follow-up and resolve claims in line with regulatory and internal guidelines.

⛳️ Requirements

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

• 2–3 years of relevant experience is required for the Associate Claims Examiner position.

• 1–2 years of life insurance experience is mandatory for the Associate Claims Examiner role.

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

• Intermediate proficiency with Microsoft Excel is required.

• Basic knowledge of Microsoft Word is required.

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

• Industry-recognized certifications are preferred.

• 3–5 years of relevant experience is necessary for the Claims Examiner position.

• 3–5 years of life insurance experience is required for the Claims Examiner role.

• Administrative experience is required for the Claims Examiner.

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

• Visa sponsorship is not available.

• Relocation assistance is not available.

🏝️ Benefits

• Competitive salary and benefits package.

• Telecommuting options may be available.

• Equal Opportunity Employer.

• Support for community and charitable initiatives and organizations.