Claim Examiner

Physicians Mutual’ s Claims team is hiring! In this role, the Claim Examiner evaluates and responds to health claim service requests for Customers, providers and entitled parties.

Duties Include:

• Following analytical and procedural duties with Customer Focus emphasis at all stages.
• With high attention to detail, evaluates claim information in conjunction with policy and benefit rider provisions, company claim philosophy, medical conditions, claim department guidelines and state insurance regulations.
• Evaluates all information received to make proper payment or reject decision.
• Effectively correspond with decisions to insured, providers and other interested parties through appropriate communication channels.

Qualifications:

• High school diploma or equivalent is necessary to obtain the reading comprehension, math and communication skills needed to perform the required duties.
• Above average written and verbal communication skills are necessary to effectively correspond with Policyowners and other interested parties.
• Ability to operate a PC and all applicable programs and applications.
• Must possess problem solving, decision-making, and organizational skills.
• Ability to function effectively in a production environment with high quality work.
• Ability to learn quickly and adapt to new insurance coverages, procedures and guidelines.
• Basic math needed to calculate benefits and interest.

Preferred Qualifications:

• Prefer a minimum of 1-2 years of previous health insurance or related experience.
• Good working knowledge of the function of other departments and their relationship to the claims process.
   

About us:

Health. Life. Retirement. The Physicians Mutual family empowers people from all walks of life to enjoy the financial security they deserve. That’s what Insurance for all of us® is about.

The Physicians Mutual family includes Physicians Mutual, Physicians Life and Physicians Select Insurance Companies. The family of companies provide health, life and retirement products, including Medicare Supplement, dental, life and supplemental health insurance, coverage for funeral pre-planning along with pet insurance for dogs and cats.

Since our start in 1902, our dedication to delivering on our promise has helped make us one of the nation’s leading health and life insurance providers. We consistently maintain some of the highest financial strength ratings in the nation from independent insurance analysts, including A.M. Best Company and Weiss Ratings, ensuring we’ll be there for our policyowners and our employees far into the future.

But the achievement we’re most proud of? We have a 95% customer approval rating — a true sign of a company dedicated to embodying its vision.