Supplemental Insurance Claims Remediation Clerk

TEKsystems
$21.00 - $25.00 / hr
life insurance, sick time, short term disability, long term disability, 401(k), retirement plan
United States, Texas, Richardson
Jan 15, 2025
Description Under supervision, this position is responsible for examining and processing all claim types including short term or long term disability, life, waiver of premium, critical illness, accident insurance and other claim type for various policies. May perform a variety of related duties or travel to client sites to discuss / resolve claim issues. Job Responsibilities: Assume responsibility for all assigned large accounts and sensitive groups to review and resolve customer problems and complaints concerning claims matters and personally handles the claim through resolution. Proactively communicate and respond to claim inquiries from insureds, beneficiaries, policyholders and internal stakeholders; resolve issues through effective verbal and written communication by involving appropriate people within, or outside the department or company; effectively and professionally represent the company in all interactions. Relieve and complete work assignments for other Claim Representatives during absences, etc. to stay within the Department's established turnaround schedule. Investigate, research, verify and diligently obtains medical information on all claim types to determine eligibility and interpret information relating to the severity of the stated disability or incident. Adjudicate claims in accordance with established policies and procedures. Interview, make calls and/or corresponds with customers to determine extent of customer concern and resolves situation in accordance with standard operating procedures. Proactively identify inconsistencies or lag in claim information and utilize effective approaches and resources to obtain clarification or verification. Obtain complete and accurate information from groups, agencies, physicians, claimants, etc., to verify and ensure claim eligibility and/or continued disability. Maintain accurate documentation of activities in claim file in accordance with company practices and procedures. Maintain thorough knowledge of all policies, statutes and regulations, medical conditions and departmental procedures to ensure proper dispositions of claims. Recommend changes to management to avoid recurring customer inquiries/problems. Adhere to quality, production, service and departmental guidelines to process claims. Provide professional, prompt and accurate customer service via telephone and in writing to members, groups, doctors, etc., in handling various claim types. Approve or deny claims within policy limits; recommend approval, denial, rescission or settlement of disputed claims. Communicate with outside attorneys, group representatives, claimants, reinsurers, and the State Board of Insurance to exchange information and respond verbally or in writing to inquiries. Assist in the preparation of grievance summaries and information for lawsuits. Coordinate, with various reinsurance companies, the gathering of information and submission of claims under the reinsurance treaties. Research cases of concern to the State Insurance Department; compiles data and composes response letter for approval by Manager. Examine and analyze life claim information and makes benefit decisions and payments on claims up to $75,000 aggregate liability. Skills* medical claims processing, Claim, data entry, microsoft office, Epic, Hospital billing, dental claims Additional Skills & Qualifications Must have experience with adjudicating Accidental, Critical, Hospital or Short term Disability claims Required Job Qualifications: Bachelor degree or 4 years of business experience. 2 years of claims experience. Problem solving and research skills. PC proficiency to include Word, Excel, PowerPoint, Outlook and Lotus Notes. Customer Service experience. Organizational skills. Experience handling multiple tasks and making priorities. Clear and concise verbal and written communication skills. Proficient in the following: Correspondence, Medical Records Review, Misrepresentation Investigation, Pre-Existing Investigation, Evidence of Insurability Review, Benefit Entitlement Review, Financial Accuracy, ERISA Guidelines, MAR Requirements, State Regulations, Contract Language, Company Financial Liability. Experience in the following core systems: ECM, STAR (Claim System), Genelco/GIAS, Siebel, UTS, Casetrak, Docsql, Benefits Manager, and ImagePlus. Experience processing one (1) of the following claim types: Life or Waiver of Premium claims. Experience in processing any of the following two (2) claim types: Critical Illness/Specified Disease, Accidental Insurance, GAP, Permanent and Total Disability (PTD benefits, Accidental Death and Dismemberment, Permanent and Total Disability (PTD), Accelerated Death Benefits. Preferred Job Qualifications: LOMA courses. Aptitude for math and critical thinking skills. Knowledge of state regulations, statutes, and ERISA. Detailed oriented. Pay and Benefits The pay range for this position is $21.00 - $25.00 * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a hybrid position in Richardson,TX. Application Deadline This position will be accepting applications until Jan 21, 2025. About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.