Claims Examiner
About The Position
As one of the world's top International Medical Insurance companies, IMG helps individuals and companies of all sizes. Every second of every day, vacationers, those working or living abroad for short or extended periods, people traveling frequently between countries, and those who maintain multiple countries of residence use our products to give themselves global peace of mind® We are looking to grow our teams with people who share our energy and enthusiasm for creating the best experience for travelers. The Claims Examiners provide a service to our policyholders by reviewing claims to determine the validity of the insurance claim filed and identify the need for further investigations. Examiners resolve medical/dental/life/trip cancellation claims; documenting actions; maintaining their imaging queues; maintaining quality audit standards and ensuring their outcomes are following the Certificate of Insurance, Policy and Plan Documents as well as legal and regulatory agencies.
Requirements
- At least 1 year of prior medical claims processing experience OR willing to consider at least 2 years of experience with coding, billing, reviewing medical records, claims research, benefits review, medical office, or any other claims related role (i.e. complex claims, LCM claims, BI claims, P&C claims, etc.)
- Knowledge of basic medical terminology
- Ability to read and interpret insurance policy/certificate wording
- Ability to research and logically consider details from multiple sources to analyze and make a determination of benefits within a productivity-based environment
- Computer skills and proficiency in operating common office equipment
- Documentation, Data Entry Skills
- High attention to detail with ability to analyze information and Problem-solving skills
- Proficiency with basic math
Nice To Haves
- Knowledge of ICD-10
- Knowledge of FDA Health and HIPAA Regulations
Responsibilities
- Determines covered insurance losses by studying provisions of policy or certificate.
- Establishes proof of loss by studying proof of claim; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims.
- Documents medical claims actions by completing forms, reports, logs, and records.
- Resolves claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter.
- Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.
- Maintains quality customer services by following core values
Benefits
- Comprehensive benefits package including Medical / RX / Dental / Vision / Life insurance
- 401k Plan with company match
- Paid Time Off and Company Paid Holidays
- Free employee parking
- On site fitness center
- Casual dress environment
- Tuition reimbursement plan
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
