Healthcare Claims Examiner

Job Description - Healthcare Claims Examiner (054274)

Capgemini is an Equal Opportunity Employer encouraging diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, national origin, gender identity/expression, age, religion, disability, sexual orientation, genetics, veteran status, marital status or any other characteristic protected by law.

This is a general description of the Duties, Responsibilities and Qualifications required for this position. Physical, mental, sensory or environmental demands may be referenced in an attempt to communicate the manner in which this position traditionally is performed. Whenever necessary to provide individuals with disabilities an equal employment opportunity, Capgemini will consider reasonable accommodations that might involve varying job requirements and/or changing the way this job is performed, provided that such accommodations do not pose an undue hardship.

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About Capgemini

Capgemini is a global leader in consulting, digital transformation, technology and engineering services. The Group is at the forefront of innovation to address the entire breadth of clients’ opportunities in the evolving world of cloud, digital and platforms. Building on its strong 50-year+ heritage and deep industry-specific expertise, Capgemini enables organizations to realize their business ambitions through an array of services from strategy to operations.

Capgemini is driven by the conviction that the business value of technology comes from and through people. Today, it is a multicultural company of 270,000 team members in almost 50 countries. With Altran, the Group reported 2019 combined revenues of €17billion.

Visit us at  People matter, results count.

• May also apply directly by sending your resume to Paige Perillard at

• Responsible for accurate/timely daily review of Long-Term Care claims and policy provisions to process payment or issue denial. This role does not involve full claim handling from claim receipt or intake to closure. In terms of claims handling, this position is specifically limited to the payment or adjudication of invoices pertaining to long term care claims.
• Responsible for the identification, analysis and application of long-term care claim product features including waiver of premium, waiting period, assignment of benefits, credits, and other applicable policy benefits.
• Meet or exceed minimum production and quality targets as approved by management.
• Respond accurately, timely and professionally to all oral and written external and/or internal correspondences received from stakeholders in regard to benefits, eligibility, claim payments, denials and/or explanation of benefits. As well as inbound claim calls.
• Maintain working knowledge of all company services pertaining to business segment, company claims, administrative and imaging software systems such as INSPRO and Microsoft applications
• Operate within company regulations regarding HIPAA, fraud, confidentiality, and private health information guidelines.
• Other duties as assigned.

• Experience with Microsoft Word, Excel and Outlook.
• Willingness to work various schedules and adapt to a changing work environment.
• Strong communication skills – verbal and written.
• Ability to disseminate and learn information in a short period of time.
• Efficient and accurate use of technology for data entry, documentation, and analysis.
• The ability to multi-task and quickly navigate multiple business tools while maintaining quality.
• Proven ability to meet deadlines.
• Ability to make a positive contribution as demonstrated by learning new skills and making suggestions for process/procedure improvement.
• Maintain client and company quality and production standards.
• Maintain knowledge of applicable company policies and procedures.

To perform this job successfully, the individual must be able to perform each essential duty effectively. The individual must possess advance product knowledge, comprehensive understanding of insurance terminology and definitions, core knowledge of company and department processes and procedures related to the ability to complete job responsibilities /duties in a proficient and professional manner.

One to Two years certificate/degree from college or technical school preferred. One or more years of claims processing experience within a claims operation.

Must have the ability to read and interpret documents such as policies and operating and procedural manuals;
Ability to write routine correspondence;
Ability to speak effectively to customers, clients or employees of the organization.

Must have the ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals;
Ability to calculate figures and amounts such as discounts, interest, and…