Key Facts

Remote From:

Full time

Senior (5-10 years)

English

Hard Skills

Process Management Medical Record Management Auditing Claims And Litigation Management Evidence Analysis Data Security Regulatory Compliance Claims And Litigation Management Insurance Law Positive Psychology

Other Skills

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Typing
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Computer Literacy
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Professional Communication
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Ability To Meet Deadlines
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Adaptability
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Multitasking
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Time Management
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Teamwork
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Customer Service
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Detail Oriented

Roles & Responsibilities

High school diploma or equivalent
Claims operations experience for Group disability, Employee Benefit, Worker Compensation, Claim Management, Overpayment Recovery, or Leave Management
6-18 months Life Insurance backend operations experience

Requirements:

Review and assess supplemental health claims to determine eligibility based on policy terms and conditions.
Gather necessary documentation from claimants, medical professionals, and other sources to support the claim evaluation process (quantitative review).
Analyze medical records, employment history, and other pertinent information to make informed decisions (qualitative review).
Collaborate with healthcare providers, employers, and other stakeholders to ensure accurate and timely processing of claims.

Navitas Partners, LLC

About Navitas Partners, LLC

Navitas Partners LLC is a diversity led business, headquartered in NJ, as a dynamic IT professional services and workforce solutions company. We believe creating the best solutions in human resource services means always going above and beyond - and people are our most important asset. Our “DNA” invokes core values of knowing, trusting and serving our relationships. The better we know our clients and candidates, the better our relationship, and the better we match the needs and exceed expectations. We want our client’s experience with us to reflect a transparent, professional and driven relationship. At Navitas Partners we strive for Excellence in People, and grow with you to become a true extension of your HR specific business requirements, while remaining sensitive to your price & business needs. Certified Diversity Employer: SBE • WOSB • WBE • MBE • NMSDC NAICS: 541511, 541512, 541513, 541519, 54164, 518210, 811212, 561320 https://form.jotform.com/223145471243247

Company type: SME

Founded: 2018

Company size: 51 - 200

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Job description

Senior Claims Examiner
Remote
3 months contract (possible extensions)

Responsibilities

Review and assess supplemental health claims to determine eligibility based on policy terms and conditions.
Gather necessary documentation from claimants, medical professionals, and other relevant sources to support the claim evaluation process (quantitative review).
Analyze medical records, employment history, and other pertinent information to make informed decisions (qualitative review).
Communicate with claimants to provide updates on their claim status and request additional information when needed.
Collaborate with healthcare providers, employers, and other stakeholders to ensure accurate and timely processing of claims.
Maintain clear and professional communication with all parties involved in the claims process.
Ensure all claim-related documents are accurately recorded and stored in the workflow systems for future reference.
Prepare detailed reports and summaries of claims for internal review and decision-making purposes.
Maintain confidentiality and adhere to data protection regulations when handling sensitive information.
Ensure compliance with industry regulations, company policies, and legal requirements throughout the claims process.
Conduct regular audits of claims files to ensure accuracy, completeness, and adherence to standards.
Participate in training sessions to stay updated on changes in policies, procedures, and regulations.

Minimum Qualifications

High school diploma or equivalent
Claims operations experience for Group disability, Employee Benefit, Worker Compensation, Claim Management, Overpayment Recovery, or Leave Management
6-18 months Life Insurance backend operations experience

Preferred Qualifications/ Skills

Strong English Communication (Both written & verbal)
Proactive communication
Multi-tasking ability
Time management
Attention to detail
Displays energy, enthusiasm, and flexibility in approaching the job
Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
Customer service focus
Basic Computer knowledge along with typing speed of 40 words/minute
Insurance knowledge