CLAIM ELIGIBILITY SPECIALIST
Looking to join a growing company dedicated to helping others? We offer that, plus competitive salaries, a culture of learning, and a fast-paced environment. This is a hybrid position with 3 days in-office. Join our team to help make a difference in the lives of others!
About Continental General:
The Continental General family of companies has provided insurance, including life and long-term care policies, to individuals and groups for over 30 years, and currently supports over 100,000 policyholders. Both our insurance company, Continental General Insurance Company, and our third-party administrator, Continental General Services, are committed to the continuous development of our infrastructure, processes, and people. The group is actively growing through expansion of both its insurance portfolio and its administrative services. With each opportunity, we take a collaborative approach to address challenges and provide unique solutions.
Responsibilities:
Investigates and maintains simple complexity claims, including but not limited to:
Reviews and evaluates coverage and / or liability.
Analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, records, or other documents) to determine eligibility claim decisions.
Establishes appropriate Plan of Care according to Claim Handling Guidelines
Accurately documents claim record with eligibility details.
Conveys simple claim details (coverage, decisions, expectations, etc.) to all appropriate parties, maintaining a professional demeanor in all situations.
Ensures claims handling is conducted in compliance with applicable statues, regulations, and other legal requirements, and that all applicable company procedures and policies are followed.
Performs other duties as assigned.
Note: Applicants must be authorized to work for a U.S. employer without sponsorship. We are unable to sponsor or take over sponsorship of an Employment Visa at this time or at any time in the future.
Education: High School Diploma or equivalent
Experience: 6 months to 3 years of related experience
Scope of Job:
Works within specific limits and authority on assignments of moderate complexity.
Handles claims of high frequency and low severity
Possesses basic functional knowledge and skills reflective of study and / or on the job development.
Possesses good verbal and written communication skills.
Performs work under moderate supervision.
Plymouth Rock Assurance
Allianz
TriWest Healthcare Alliance
International Programs Group
