Claims Examiner II

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Deliver customer service to both internal and external stakeholders.

• Identifies the necessary actions to fulfill customer requirements and showcases adaptability and responsiveness while handling routine tasks independently.

• Acknowledges issues or concerns within designated areas of responsibility, articulates their impact on the customer’s service experience, and recommends process enhancements.

• Facilitates and advocates for change management and departmental or enterprise initiatives within specified areas of responsibility.

• Evaluates increasingly complex claim submissions for payment.

• Ensures the integrity and completeness of submitted claims.

• Escalates claims-related issues or concerns to senior team members and/or management.

• Processes increasingly complex partial disability claims for payment or denial, adhering to established procedures and guidelines in a timely manner, while meeting departmental quality and production standards.

• Reviews and provides detailed responses to complex inquiries from internal and external stakeholders by utilizing expanded knowledge.

• Executes routine tasks independently, in alignment with established procedures and guidelines, in a timely manner while meeting deadlines effectively.

• Makes both routine and non-routine decisions, applying limited but progressively more discretion within the role.

⛳️ Requirements

• 2 - 3 years of claims experience that closely aligns with the specific responsibilities of this position.

• High School diploma or GED (Minimum Required).

• Capability to interpret and apply common sense understanding to execute various instructions provided in written, oral, or diagram form.

• Proficient in mathematical concepts such as addition, subtraction, multiplication, division, averages, and/or variances.

• Ability to collaborate effectively in a team environment.

• Familiarity with the DocsNet claim system (Nice-to-have).

• Exhibits excellent written and verbal communication skills (Nice-to-have).

• Ability to read, analyze, and interpret internal documents such as policies and standard operating procedures (Nice-to-have).

• Capability to perform under pressure in emergency, critical, or hazardous situations (Nice-to-have).

• Demonstrates outstanding organizational skills, with the ability to prioritize tasks and manage multiple responsibilities while maintaining strict attention to detail (Nice-to-have).

🏝️ Benefits

• PTO/parental leave.

• Competitive 401K and employee benefits.

• Complimentary financial counseling.

• Health coaching services.

• Employee assistance program.

• Tuition assistance program.

• Flexible work arrangements to suit your needs.

• Access to effective productivity tools and technology training.