Bilingual Claims Examiner

Description:

Reporting to the Senior Manager, Claims, we are adding a Bilingual Claims Examiner to our team. You will be a key player on the team, balancing a wide range of high volume, complex claims. Focusing on traditional insurance claims with the room to expand into other lines of business, you will spend your days reviewing, researching, verifying, approving, or denying claims. In addition, you will work closely with senior team members, the Manager, customers, and external contacts.

What's in it for you

Autonomy, camaraderie, career growth. This is a chance to work on a diverse range of claims as we offer many products to our customers. You will be fully onboarded and trained, be partnered with senior team members on your initial claims, and have ongoing support and mentorship. There is endless opportunity to learn the industry and grow within the team, moving up to a more senior role, including a Team Lead or exploring other areas of the company.

What you will do

Respond to inquiries by mail or phone. You will place and accept calls involving customers, physicians, lawyers, and investigators. You will respond to questions regarding claims, eligibility verification, and payments. You will review supportive documentation, benefit forms, and certificates.
Analyze. You will accurately examine traditional insurance claim files within the processing guidelines according to the certificate provisions; updating information; and document the claim file with written notations of the claim status and related payment information.
Document. You will prepare the policy decision for additional review if applicable. You will create detailed claim documentation, writing letters, and completing associated forms.