Hybrid Supplemental Health Claims Examiner in Lombard

Hybrid Temp-to-Hire Supplemental Health Claims Examiner

Our client a busy and fast-growing Insurance Company is currently looking to fill a hybrid temp-to-hire, Supplemental Health Claims Associated position. You ideally must have at knowledge in one (1) of the following claim types:
Critical Illness/Specified Disease/Specified Disease, Accidental Insurance, Hospital Indemnity or Short-Term . You must have a Bachelor’s Degree or four (4) years of equivalent business/related work experience equivalent work experience.
There is expected to be some mandatory onsite training must be completed prior to working a remote work schedule
. A company laptop will be provided for work purposes only. This is a temp-to-hire full-time position M-F from (8:00am to 4:30pm).

• Responsible for examining and processing all claim types including Accident Insurance, Critical Illness/Specified Disease, Hospital Indemnity Life product claims and weekly income claims in accordance with established policies and procedures.
• Consistently adhere to the documented workflow guidelines and established procedures.
• Calculate multiple benefits due based a combination of information on claim forms, medical information, plan certificates/contract and regulatory guidelines and administer provisions accurately, including, but not limited to, misrepresentation or pre-existing Investigation, Evidence of Insurability Review, Benefit Entitlement Review, Financial Accuracy, ERISA Guidelines, MAR Requirements, State Regulations, Company Financial Liability as applicable.
• Obtain complete and accurate information from groups, agencies, physicians, beneficiaries, claimants, etc., to verify and ensure claim eligibility and resolve investigation issues.
• Promotes a positive customer service image through prompt, accurate and courteous responses to customer information needs and resolve situations in accordance with SOP
• Fully investigate all relevant claim issues, provide approvals, payments, or denials promptly and in full compliance w/departmental procedures and Unfair Claims Practice regulations.

• Bachelor’s degree or 4 years of equivalent business/related work experience.
• Good decision-making, problem solving & research skills w/ ability to analyze complex info.
• PC proficiency to include MS Word, Excel, SharePoint, and Outlook.
• Excellent customer service skills.
• Detail oriented/maintain high level of quality & accuracy in a fast-paced environment.
• Clear and concise verbal and written communication skills.
• Knowledge of medical terminology

• HIAA, LOMA or ICA courses a plus.
• Aptitude for math and critical thinking skills.
• Knowledge of state regulations, statutes, and ERISA.
• Knowledge in any of the following core systems: ECM, STAR (Claim System), Genelco/GIAS, Salesforce, UTS, Benefits Manager.
• Knowledge in one (1) of the following claim types:
  Critical Illness/Specified Disease/Specified Disease, Accidental Insurance, Hospital Indemnity or Short-Term .
• Ability to fluently speak and write Spanish a plus.

We are employment specialists who have worked in heath care and managed care industry for over a total of 25 years. We staff temp, temp to hire, and direct hire placements

We are employment specialists who have worked in heath care and managed care industry for over a total of 25 years. We staff temp, temp to hire, and direct hire placements