Claims Examiner I, II, or Sr.

When it comes to making a meaningful difference in the lives of our customers and employees, USAble Life is always ready.  We are a diverse group of individuals working together to go the extra mile. Through our DEI initiatives, employees feel empowered to bring their talents and voice to our culture.  

Our passion for delivering the best products is matched only by our passion for our people. We are committed to making a meaningful difference in the lives of others which extends beyond our office walls. USAble Life has a long tradition of supporting our communities, and we’re proud of the fact that our employees share that commitment.  

We have been recognized as a “Best Places to Work” in Arkansas, Florida, and Hawaii. You’ll be rewarded with opportunities for personal and professional development and opportunities for advancement.  This, coupled with our engaging culture and a comprehensive benefits package, ensures we are committed to our employees.  

Check out how we make a meaningful difference in the lives of others! 

https://player.vimeo.com/video/518665804 

What We Offer You: 

• A culture that values employees and celebrates, empowers, and inspires a diverse workforce
• Outstanding and affordable benefits package 
• Yearly bonus potential and annual increases
• PTO provided at date of hire
• 11 paid holidays
• 401(k) with up to 6% match; fully vested from day 1
• Remote opportunities with company-provided equipment
• Team-oriented, collaborative group of peers
• Career advancement opportunities
• Tuition Reimbursement
• Employee Assistance Program
• Inclusion Council and Employee Resource Groups
• Recharge Days and Volunteer Time Off
• This is a remote position.

Life Takes You Places!  Are you ready to join us? 

Compensation: The starting base salary range for a Claims Examiner I is $39,200.00 to $53,900.00. The range for a Claims Examiner II is $43,900.00 to $60,325.00. The range fir Sr. Claims Examiner is $49,200.00 to $67,575.00. Actual salaries will vary by geographic location and are based on factors such as candidate’s qualifications, experience, skills, competencies, and company tenure & equity. In addition to base compensation, this role is eligible for an annual incentive plan based on company performance and individual performance. 

Claims Examiner I Overview

Performs diverse duties relating to the processing, review, and adjudication of claims; including reviewing for accuracy, file and claim completeness, reviewing coverage and approving payment or denial. Works in a learning and mentoring relationship capacity in conjunction with a more senior Claims Examiner until fully competent to independently receive claims documents. Communicates with claimants, group policy holders, medical providers, and internal staff on claims related issues. Updates tracking systems and processing systems as necessary. Performs other duties as assigned. 

Claims Examiner II Overview

Performs diverse duties relating to the processing, review, and adjudication of claims; including reviewing for accuracy, file and claim completeness, reviewing coverage and approving payment or denial. Communicates with claimants, group policy holders, medical providers, and internal staff on claims related issues. Updates tracking systems and processing systems as necessary. Provides assistance and feedback to less experienced staff members as assigned. Performs other duties as assigned. 

Sr. Claims Examiner Overview 

The Sr. Claims Examiner role performs diverse duties relating to the processing, review and adjudication of claims; including reviewing for accuracy, file and claim completeness, reviewing coverage and approving payment or denial. Work in a training and learning capacity in conjunction with a more senior Claims Examiner. Communicates with claimants, beneficiaries, and other stakeholders. Utilizes multiple systems to review adjudicate and pay benefits in accordance with our policy. 

Essential Duties

• Reviews claim information for accuracy, completeness, and coverage in force
• Contacts claimants, group policyholders or medical providers for additional information
• Composes and prepares correspondence to insureds, groups, beneficiaries, and physicians
• Provides complete and thorough file documentation including detailed explanations, recommendations, and documentation of actions taken
• Analyzes data and adjudicates claims in accordance with policy provisions
• Maintains workload inventory on a daily basis.  May perform other duties as assigned
• Required Knowledge, Skills, and Abilities
• Knowledge of diagnosis and procedure codes and general medical terminology
• Proficient in MS Office
• Excellent verbal and written communication skills including professional telephone skills and the ability to compose professional correspondence
• Demonstrated leadership skills and the ability to assist and guide others
• Attention to detail and ability to maintain a low error rate
• Organization skills
• Ability to prioritize tasks, critical thinking, multi-task, and handle deadlines

Claims Examiner I Required Education and Experience

• High school diploma or equivalent
• 2 - 4 years of related experience
• Or, equivalent military experience

Claims Examiner II  Required Education and Experience

• High school diploma or equivalent
• 4 - 6 years of related experience
• Or, equivalent military experience

Sr. Claims Examiner Required Education and Experience

• Associates Degree or equivalent professional experience
• 3+ years claims experience.

Claims Examiner I Preferred Education and Experience

• Associate degree
• 3 years of related experience

Claims Examiner II Preferred Education and Experience

• Associate degree
• 5 years of related experience

Sr. Claims Examiner Preferred Education and Experience:

• Bachelor's Degree in a business-related field.
• LOMA courses 280/281 and 290/291.
• 3 or more years of insurance industry experience
• Medical coding experience

Working Conditions (Physical Demands):

• Environment
• Essential physical requirements (such as typing, standing, prolonged sitting)
• Indicate if required to work weekends, nights, or on call as regular part of job
• Travel requirements

Disclaimer:

This job description is intended to convey information essential to understanding the scope of the position and its general requirements. It is not exhaustive and may be subject to modification at any time to meet the evolving needs of the organization.  

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