Note: The job is a remote job and is open to candidates in USA. Renaissance Benefits is seeking an experienced Life and Disability Claims Examiner to join our growing team! The Life & DI Claims Examiner II is responsible for evaluating and processing group insurance claims for payment or denial according to the terms and conditions of each policy.
Responsibilities
• Review submitted claims to ensure proper guidelines have been followed and eligibility requirements have been met. Contact group policyholders, beneficiaries or other third parties for missing information
• Consult with other professionals, such as management, senior team members, and other available resources, on complex claims
• Communicates with the claimants and employers to set expectations regarding return to work or claim status and next steps. Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence. Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system
• Determines benefits due, makes timely claims determinations, payments/approvals and adjustments
• Investigate claims. Search database to obtain background information and interview claimants and witnesses. Consult police, hospital records and policy files to verify information reported in a claim
• Calculate and authorize the appropriate payment for claim or refer to manager for additional review
• Assist in handling claims with suspected fraudulent or criminal activity. Access personal information and past claims histories to establish whether a claimant has ever attempted insurance fraud
• Answer verbal and written inquires and customer service queued calls on Group claims from insureds, group policy holders, agents, physicians, hospital attorneys, Workers' Compensation Board, Workers' Compensation carriers, State agencies, other insurance carriers, TPA's, Reinsurers and internal staff
• Respond to requests for information or return calls within established service guidelines
• Adheres to determined quality standards for the handling of calls and written inquiries
• Other duties and responsibilities as needed or assigned
Skills
• Associate's degree in business
• Basic proficiency in Microsoft Word/Office Suite
• Intermediate proficiency in Microsoft Excel
• Ability to perform work accurately and thoroughly
• Ability to pay close attention to detail
• Ability to prioritize and organize a heavy workload
• Bachelor's degree
• 2-4 years of related industry experience
• Disability and/or life insurance claims administration experience
• Knowledge of ERISA regulations, statutory disability claims administration, required offsets and deductions, disability duration and medical management practices and Social Security application procedures
• Experience with claims management systems and electronic/paperless claims processing
Company Overview
• Delta Dental of Michigan, with its affiliates in Arkansas, Indiana, Kentucky, New Mexico, North Carolina, Ohio and Tennessee It was founded in 1957, and is headquartered in Okemos, Michigan, USA, with a workforce of 501-1000 employees. Its website is http://www.deltadentalmi.com/.