Claims Processor Bilingual

Job Description:

The ability to review proofs of loss quickly, ensure claims are administered in accordance with policy provisions and the company’s practices and philosophy, and work well with others. This requires a detail-oriented mind set, critical thinker who is willing to take initiative and work consultatively with others. This person will work effectively and efficiently to meet expected turnaround times. We look for our claim examiners to be analytical and provide prompt, fair payment of all legitimate claims.

Essential Job Duties:

1. Answer and respond to inbound telephone inquiries from policy beneficiaries, or their representatives, and provide excellent service during their claims inquiries

2. Strategic thinking and decision-making skills.

3. Ability to work well in a team based environment

4. Maintains an excellent attendance record

5. Review policy contracts and determine if coverage is applicable

6. Review and prepare claims for processing; maintain claims information in the claims app

7. Determines base payment by referring to policy coverage and limits, and determines course of action (i.e., payment, further investigation or denial)

8. Maintain the assigned follow ups and pending inventory

9. Cross train on various product processing within the claims department

10. Correspond with agents, policyholders, hospitals, doctors, attorneys, beneficiaries and claimants for information regarding the claim

11. Correspond with customers for resolutions of concerns through outgoing calls or written communications

12. Process verifications and manage the verification inventory

13. Assess, research and correct claims discrepancies, collaborate with other members of the team as needed.

14. Comply with HIPAA and other privacy regulations.

15. Maintain complete confidentiality of company business.

16. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

17. Participation in educational seminars, webinars, and local claims meetings.

18. Approval limit will vary with experience level

a. Based on experience could be approved to release up to $1000 without secondary review

19. Meet the minimum standard expectations for Claims Examiner-Processor

Minimum Qualifications:

1. Bachelor’s degree preferred. However, insurance related work experience and strong computer skills acceptable.

2. Must be fully bilingual, written and verbal in Spanish, Portuguese optional.

3. Complete LOMA 1 & 2 (280 & 290) courses, Associate, Customer Service (ACS) designation and working toward the Associate, Life & Health Claims designation (ALHC).

4. Associate, Life & Health Claims (ALHC) and Associate, Life Management Institute (ALMI) certifications are necessary for advancement to a management position.

Knowledge, Skills, and Abilities:

1. Skill in Microsoft Office products

2. Excellent analytical, organizational and interpersonal skills

3. Well-developed written and verbal communication skills

4. Strong math and/or financial skills

5. Expected to get certification through coursework. Certification is required for advancemnt to Claims Examiner or claims management positions. Many options are available through LOMA, the International Claim Association (ICA) and the American College

6. Ability to balance prompt claim settlement against the need to be accurate in determining liability for each claim.

7. Ability to work in multiple systems and applications

8. Ability to establish rapport and build relationships in a professional manner

9. Ability to address issues/concerns in a professional manner

10. Ability to develop and maintain positive working relationships with internal/external stakeholder

11. Ability to operate in a fast-paced environment shaped by constant change and innovation

Miscellaneous Requirements:

1. Ability to work Monday-Friday, 8AM – 5PM with occasional flexible hours, overtime, weekends, especially during peak seasons

Work Environment

Primarily indoors with heating and cooling regulated in a general office environment. The noise level in the work environment is generally low.

Physical Requirements

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Ability to reach high and low; open, close and retrieve files from file cabinets as well as operate computer keyboard and appropriate office equipment. The position requires the ability to frequently stand, walk, sit for long periods of time, lift up to 15 lbs., open filing cabinets and bend or stand on a stool as necessary.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Physical setting:

• Office

Schedule:

• Monday to Friday

Ability to commute/relocate:

• Austin, TX 78758: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Microsoft Office: 1 year (Preferred)
• Customer service: 1 year (Preferred)

Language:

• Spanish (Required)

Work Location: One location