Claims Approver

Overview:

Summary of Responsibilities:

Accumulates and evaluates information from policyholders, attorneys, physicians, hospital personnel, police departments, employers, State Medicaid personnel, funeral homes, Probate courts and other professionals needed to process and pay claims. Provides prompt and courteous customer service to external and internal customers. Distributes incoming mail and maintains files housed in the department. Audits paid claims, codes statistical data related to cause of death and aids in the production of monthly and quarterly reports.

Position Responsibilities:

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  Reviews, processes and pays claims on death, cancer, ordinary/industrial accident and health, and total and permanent disability according to Company procedures and appropriate state regulations.

• Determines proper payees for payment to assure that the Company is fully discharged from liabilities associated with claims.

• Identifies claims that meet qualifications for payment via Life Accounts, and completes processing necessary to set up the accounts.

• Enters claims into systems, maintains pending files, matches output to the appropriate file and distributes new mail.

• Handles incoming calls from policyholders, insureds and other external or internal customers promptly and professionally.

• Audits paid claims for accuracy and completeness. Verifies that all needed information was received and codes statistical data regarding cause of death as required.

• Performs other duties as assigned by management.

Selection Criteria:

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  Experience in maintaining a high degree of accuracy associated with high volumes of work and/or multiple duties. Ability to continuously make repetitive motions of the wrists, hands and/or fingers.

• Demonstrated experience maintaining the confidentiality of information handled in the course of completing work.

• Proven experience working in a customer-oriented field and effectively articulating information to clients in a patient and understanding manner while managing multiple tasks.

• Proven strong analytical skills, including demonstrated experience identifying and quantifying problems and providing effective resolutions when dealing with multiple alternatives.

• Demonstrated experience working effectively within a team. Must provide examples from work experience of going above and beyond the call of duty to assist team members.

• Must provide examples of working under multiple deadlines and minimal supervision. Must be able to cite examples of self-motivation and effectively completing work when given little or no direction.

• Demonstrated excellent verbal and written communication skills with the ability to successfully interpret and communicate business needs to internal or external customers in a clear, focused and concise manner while following proper rules of punctuation, dictation and style. This would include strong telephone communication and etiquette skills.

• Proven experience adapting and demonstrating flexibility associated with changes to policies/procedures.

• Demonstrated experience acquiring and assimilating new knowledge and skills. Must be able to cite examples of work experience wherein new skills were applied to successfully complete assigned tasks.

Work Setting:

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  This position works in an office setting and remains continuously in a stationary position for long periods of time while working at a desk, on a computer or with other standard office equipment, or while in meetings.

Educational Requirements:

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  High school diploma.

Computer skills and knowledge of hardware & software required:

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  Working knowledge of word processing, spreadsheet and Microsoft office applications.

Certifications & licenses (i.e., Series 6 & 63, CPA, etc.):

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  None required.

Position Demands:

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  Extended hours required during peak workloads or special projects.