What are the responsibilities and job description for the Senior Claim Examiner position at Physicians Mutual?
Physicians Mutual’s Claims team is hiring a Senior Claim Examiner for their Long-Term Care team. This role evaluates and responds to claim service requests for Companies’ customers, medical providers and entitled parties.
Responsibilities Include:
- Analyzes all claim information received in conjunction with all company Long Term Care polices and riders in order to determine benefit eligibility.
- Resolves claims in accordance with claim procedures, policy provisions and limitations, policy application, underwriting guidelines, medical conditions, company philosophy and state insurance laws.
- Corresponds with insureds, doctors, facilities, and other third parties to collect data.
- Processes payment or explains reject decisions to customers through appropriate communication channels.
- This position requires continuing education and development of new auditing skills.
Qualifications:
- Approximately 2-3 years of increasingly responsible auditing experience in Long Term Care, Disability, or Health Insurance is preferred but not required.
- Strong written and verbal communication skills are necessary to effectively correspond with Policyowners and other interested parties. Ability to handle complex claim situations. This position does about 60% of their work day communicating with policy holders.
- Must possess sophisticated problem solving, decision-making, and organizational skills.
- Ability to function effectively in a production environment with high quality work.
- 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 Insurance Company and Physicians Life Insurance Company. Physicians Mutual Insurance Company offers reliable dental and supplemental health insurance (and now, pet insurance!). Physicians Life Insurance Company provides important Medicare Supplement and life insurance coverage. The company additionally offers coverage for funeral pre-planning to help meet the growing needs of funeral home owners and the families they serve.
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. In fact, we are rated in the top 1% of insurance companies. 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
