Voluntary Benefits Claims Examiner
Offer summary
Qualifications:
Minimum of 6 months experience in Medical Insurance Claims Processing, Minimum of 1 year experience in a contact center/call center, Knowledge of medical terminology and ability to read medical records, Strong mathematical skills and proficiency in Windows environment, including Word and Excel..Key responsabilities:
- Document all claim information including phone calls and correspondence.
- Utilize effective communication to obtain and provide information to claimants and employers.
- Read medical records to confirm benefits available to members and apply plan provisions accordingly.
- Adhere to client Service Level Agreements and manage multiple priorities under tight time constraints.
Job description
The Voluntary Benefits Claims Examiner will support a large Group Insurance Business contract is responsible for the calculation of Voluntary Benefits across limited products according to Plan Provisions. Voluntary Benefits can include wellness, hospital indemnity, accident and critical illness products. This position requires the knowledge and understanding of Voluntary Benefits policies and procedures with a medical terminology background and ability to read medical records outside of ICD’s, CPTs and HCPC to appropriately calculate the benefits due. You will be expected to follow through timely on claim processing, utilize judgment, and assess risk when rendering claim decisions. Able to communicate with various constituents with limited guidance and learn and transact using the client s systems. Expected to communicate clearly concisely to influence return to work, discuss terms of the certificate, and the basis of payment nonpayment.
Key Responsibilities:
Document all claim information including phone calls and correspondence.
Utilize effective communication to obtain information both verbally and in writing and provide information to the claimant and employer.
Ability to read multiple pages of medical records to confirm benefits available to the member.
Ability to apply plan provisions understand the needs of the clients.
Expected to adhere to client Service Level Agreements and department s product s key performance requirements and any reporting.
Able to utilize strong organizational skills to manage multiple priorities while working under tight time constraints, possess the ability to work through ambiguity, and work effectively with various vendors with strong interpersonal skills.
Willing to support special internal functional projects and ad hoc requests as required.
Able to work cohesively with Subject Matter experts to support the day to day tasks, able to anticipate, identify, and resolve complex issues problems.
Able to communicate risks issues to supervisor and help with the resolution, as needed.
Provide exceptional customer service either over the phone or through email.
Able to provide leadership updates progress reports on training curriculum.
Utilize tools independently and accurately to identify work to be completed.
Professional and detailed verbal skills for outbound calls to obtain medical records or claim details to gather data to work claim to completion.
Basic Qualifications:
Minimum of 6 months experience in Medical Insurance Claims Processing
Minimum of 1 year experience in a contact center/call center.
Preferred Qualifications:
Group Life/Disability/ Voluntary Claims experience
Bachelor s Degree
NY Adjustor License
Strong mathematical skills
Professional Skills:
Proficiency in Windows environment, including Word and Excel
Medical terminology knowledge
Strong written and verbal communications required
Detailed oriented with strong time management skills
Job Requirement: Schedule flexibility to work a schedule from 7 am to 7 pm CST
Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience. As required by local law, Accenture provides a reasonable range of compensation for roles that may be hired in California, Colorado, District of Columbia, Illinois, Maryland, Minnesota, New York or Washington as set forth below.
We accept applications on an on-going basis and there is no fixed deadline to apply.
Information on benefits is here.
Role Location Hourly Salary Range
California $19.71 to $31.15
Colorado $19.71 to $26.88
District of Columbia $21.01 to $28.65
Illinois $18.27 to $26.88
Minnesota $19.71 to $26.88
Maryland $18.27 to $24.90
New York $18.27 to $31.15
Washington $21.01 to $28.65
About Accenture
We work with one shared purpose: to deliver on the promise of technology and human ingenuity. Every day, more than 775,000 of us help our stakeholders continuously reinvent. Together, we drive positive change and deliver value to our clients, partners, shareholders, communities, and each other.We believe that delivering value requires innovation, and innovation thrives in an inclusive and diverse environment. We actively foster a workplace free from bias, where everyone feels a sense of belonging and is respected and empowered to do their best work.At Accenture, we see well-being holistically, supporting our people’s physical, mental, and financial health. We also provide opportunities to keep skills relevant through certifications, learning, and diverse work experiences. We’re proud to be consistently recognized as one of the World’s Best Workplaces™.Join Accenture to work at the heart of change.Visit us at www.accenture.com
What We Believe
We have an unwavering commitment to diversity with the aim that every one of our people has a full sense of belonging within our organization. As a business imperative, every person at Accenture has the responsibility to create and sustain an inclusive environment.
Inclusion and diversity are fundamental to our culture and core values. Our rich diversity makes us more innovative and more creative, which helps us better serve our clients and our communities. Read more here
Equal Employment Opportunity Statement
Accenture is an Equal Opportunity Employer. We believe that no one should be discriminated against because of their differences, such as age, disability, ethnicity, gender, gender identity and expression, religion, or sexual orientation.
All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.
Accenture is committed to providing veteran employment opportunities to our service men and women.
For details, view a copy of the Accenture Equal Employment Opportunity and Affirmative Action Policy Statement
Requesting An Accommodation
Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodations once hired.
If you would like to be considered for employment opportunities with Accenture and have accommodation needs for a disability or religious observance, please call us toll free at 1 (877) 889-9009, send us an email or speak with your recruiter.
Other Employment Statements
Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.
Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.
Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.
The Company will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Additionally, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information.
California requires additional notifications for applicants and employees. If you are a California resident, live in or plan to work from Los Angeles County upon being hired for this position, please click here for additional important information.
Please read Accenture’s Recruiting and Hiring Statement for more information on how we process your data during the Recruiting and Hiring process.
Required profile
Experience
Other Skills
- Communication
- Microsoft Excel
- Time Management
- Customer Service
- Organizational Skills
- Problem Solving
- Analytical Skills
- Social Skills
- Detail Oriented
- Physical Flexibility
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