What are the responsibilities and job description for the Claims Examiner position at ManhattanLife Insurance & Annuity Company?
Scope and Purpose:
The Entry Level Customer Claims Advocate will support our organization's Claims team. Our Customer Claims Advocate will evaluate and process medical claims submissions while also proactively assisting the Insured to obtain documents from medical providers and their primary insurance company. When the need arises a Customer Claims Advocate will demonstrate excellent service to resolve customer inquiries and issues in a timely manner. Experience working with insurance or working in a financial setting is preferred but not required. On the job training will be provided to the candidates that are selected for this position. The successful completion of LOMA designations is also preferred but not required.
Duties and Responsibilities:
- Process insurance claims with adherence to company policies and contract provisions in full accordance with the law.
- Research complex claims previously or currently being processed and explain benefit details.
- Evaluate claims based on documentation received and provide timely follow-ups for claims being adjudicated.
- Coordinate with our Insured, their medical provider or primary insurance company for required documentation.
- Answer inbound calls to educate and assist customers regarding their claim as needed.
- Handle escalated calls with empathy and dedicated service.
- Make decisions and ensure the successful resolution of inquiries and complaints by preparing accurate and timely activity reports.
- Communicate via written correspondence or e-mail to claimants.
Minimum Qualifications:
Associate's degree, an internship or prior work experience in a corporate insurance or financial office is preferred.
Knowledge, Skills and Abilities:
- Prior medical health insurance experience is a plus.
- Solid knowledge of ICD9, ICD-10 or medical coding.
- Understanding of basic medical terminology.
- Ability to multitask while using various computer applications.
- Ability to read and understand policy language.
- Ability to work independently and in a team environment.
- Professional able to project a clear, confident and friendly voice on the phone understanding that our customers are reaching out to get an answer or request service at an important time in their lives.
- Inbound customer service experience, preferably in an insurance or financial setting.
- Call center experience is a plus.
- Bilingual is a plus as we have many customers who prefer to speak Spanish.
- Intermediate Word and Excel skills are preferred.
Travel Requirements:
This position may require light travel within a ten-mile radius from one office location to another as needed.
Professional Development:
- Establish annual objectives for professional growth.
- Keep pace with developments in the discipline.
- Learn and apply technologies that support professional and personal growth.
- Participate in the evaluation process.
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee is regularly required to stand; walk; use hands to finger, handle or feel objects, type, and use mouse; reach with hands and arms and talk and/or hear. The employee is required to sit for extended periods of time. The position may require lifting, pulling or moving items weighing upwards of 10 pounds as it relates to office or desk supplies.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee regularly works in an office environment. This role routinely uses standard office equipment such as computers, phones via WebEx, physical phone while in office, and photocopiers when necessary.
Other Duties:
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to the job at any time without notice.
AAP/EEO Statement:
ManhattanLife prohibits discrimination based on race, religion, gender, national origin, age, disability, veteran status, marital status, pregnancy, gender expression or identity, sexual orientation, or any other legally protected status. EOE Employer/Vet/Disabled. ManhattanLife values differences. We are committed to fostering an environment that attracts and retains a diverse workforce. With individuals from a variety of backgrounds, ManhattanLife will be better equipped to service our customers, increase innovation, and reduce risks. We encourage the unique perspectives of individuals and are dedicated to creating a respectful and inclusive work environment.