Critical Illness Claims Rep

Critical Illness Claims Rep

Location:

Minneapolis, MN (Hybrid, 2-3 days onsite)

Duration: 12 Month Contract +

Pay Rate: 22
-25/hr.

Responsible for interpreting contract language and processing claims with high complexity. Provide a high quality of service with minimal direction, consistent with regulatory and compliance requirements.

• Analyze and determine Critical Illness claim processing in an accurate and timely manner, including payment, denial, and requests for additional information.
• Create and maintain excellent working relationships and communication with internal and external customers.
• Actively participate in root‑cause problem‑solving activities in a team environment.
• Manage work queue assignments within agreed SLAs, and support others in the same.
• Handle complex claims, including communicating with customers by phone and providing empathy and de‑escalating measures for sensitive issues.
• Perform other duties and projects as assigned.

• Experience with voluntary Critical Illness Insurance benefits preferred, including complex medical review experience.
• Strong ability to decipher medical terminology and documentation to connect with policy definitions and determine if all conditions of the benefit are met.
• Interpret diagnoses and clinical evidence within medical records to determine when an individual was diagnosed with their condition(s).
• Reduce risk through attention to detail to maintain compliance guidelines and ensure decisions are fully supported by documentation and policy language.
• Strong written and oral communication capabilities to provide clear, policy‑based denial letters to customers.
• Understand Must Not Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand Mand…