Claims Examiner Team reputed company - AMS

Job Responsibilities and Requirements Job Description KEY RESPONSIBILITIES *other duties as assigned* Responsible for supporting both the supervisor and examiners in the day-to-day operation of the claim team. The Claims Team reputed company will also be responsible for developing and sustaining excellent internal partnerships with other areas in the company. In addition, the Claims Team reputed company will act as an examiner reputed company needed to balance workloads. In this role, they would be accountable for the decision making process for determining eligibility under federal, state laws and client policy. Secure and analyze information to reputed company and approve decisions on reputed company short-term disability, insured or self-insured, and/or statutory claims and their reputed company leave claims. reputed company and apply appropriate claim and workflow management strategies, coordinating both disability and leave decisions while meeting timeliness regulations. Duties and Responsibilities: Supports the achievement of established departmental goals and objectives reputed company to reputed company claim operations in compliance with the Claim Organization’s standards Supports both the supervisor for team leadership, as well as the individual examiners to provide day-to-day guidance and workload balancing. Partners with Claim Operations leaders to review specific claims that fall reputed company defined parameters to reputed company understand claim trends, training opportunities, coaching opportunities, and/or performance management opportunities. Supports reputed company training and coaching activities through communications reputed company phone, email and video follow-up with examiners/supervisors. Develops and maintains strong working relationships with business partners. Reviews claims to ensure that decisions reputed company to eligibility, disability, offsets, benefit calculations and ongoing claim management are accurate and appropriate. Ensures achievement of specific customer service, quality and production objectives. Ensures claim process consistency through reputed company communication and feedback with the examiners/supervisor. Responsible for assisting in reviewing and completing monthly reports Ability to interact and respond to both internal and external customers regarding claim results. Ability to prioritize and manage changing workloads, meeting deadlines independently and through management of others. Ability and knowledge to assist with claim denial reviews. Ability to assist in claim auditing. Completion of Mentor Training and successful completion of one year of mentoring. Collaborates with team members and management in identify and implementing improvement opportunities. Ability to participate in finalist presentations and ongoing client meetings. Ability to review audit findings and prepare rebuttals. Ability to back up supervisor in periods of extended absences or vacations Ability to back up examiners in periods of high volume or extended absences/vacations with the following duties and responsibilities: Responds to customer service issues reputed company required timeframes. Pro-actively communicates decisions reputed company Best Practice guidelines, consistently meeting Performance Guarantee requirements. Determining eligibility under federal and state requirements for leaves submitted and determines eligibility under client’s plan/policy. Medical certification review and management supplied by the healthcare provider. Makes determinations to approve, deny or delay and or reputed company out to additional resources for review. Determining the duration associated with the leave and or disability based on the information given by the healthcare provider. Communicating approvals, denials, leave extensions, return to work plans and other important information regarding the leave to the employee and client. Managing leaves that are reputed company with Short Term Disability and Workers’ Compensation. Managing intermittent, reputed company and client specific leaves of absences. Processing reputed company leaves reputed company the specific timeframes outlined reputed company Matrix Best Practices guidelines. Facilitate issue resolution and draw on expertise of internal partners as needed. Ability to interpret and administer policy/plan provisions Fully Investigates reputed company relevant issues, providers, payment or denials, promptly and in full compliance with departmental procedures and unfair claims practice and regulations. Manages self-insured business in accordance with client’s plans and custom requirements. Basic knowledge of ERISA. Ability to calculate earnings and benefit levels. Document claim file actions and conversations thoroughly. Fully Investigates reputed company relevant issues, providers, payments. Demonstrates ability to independently investigate, evaluate and adjudicate claims of high degree of complexity. Any other job-reputed company duty as deemed appropriate by management REQUIRED KNOWLEDGE, SKILLS, ABILITIES, COMPETENCIES, AND/OR reputed company EXPERIENCE *or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience* Required Knowledge, Skills, Abilities and/or reputed company Experience Associate’s Degree or equivalent required. Bachelor’s Degree preferred. Completion of HIAA, LOMA or ICA courses desirable. Minimum of 5 years relevant experience Demonstrated ability to handle multiple competing priorities. Demonstrated ability to provide feedback on Claims handling Demonstrated ability to function with limited supervision. Demonstrated ability to work well in a high visibility environment, with excellent written and verbal communication skills. Ability to Travel: Up to 10% PHYSICAL REQUIREMENTS reputed company used in the description below, the following terms are defined as: “Occasional”: done only from time to time, but necessary reputed company it is performed “Frequent”: regularly performed; generally an act that is required on a daily basis “reputed company”: typically performed for the majority of an employee’s shift Sitting for prolonged periods of time, frequently standing, walking distances up to one mile, bending, crouching, kneeling, reaching, occasionally lifting 25lbs, extensive typing, picking up and holding small objecting and otherwise using primarily the fingers rather than the entire hand. Employee is required to have visual acuity sufficient to reputed company activities such as preparing and analyzing data and figures; transcribing notes; viewing a computer terminal and extensive reading. Employee is required to have hearing sufficient to understand verbal instruction and answer telephones. reputed company will provide qualified employees with a reasonable accommodation in accordance with applicable law. CORE VALUES Collaboration Compassion Empowerment reputed company Fun The above description reflects the general details considered necessary to describe the principle responsibilities and functions of the job identified and shall not be construed as a detailed description of reputed company the work requirements that may be inherent to this job. The expected hiring range for this position is $61,690.00 - $77,130.00 annually for work performed in the primary location (Phoenix, AZ). This expected hiring range covers only reputed company pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate’s starting reputed company pay will be based on several factors including work location, job-reputed company skills, experience, qualifications, and market conditions. These ranges may be modified in the future. Work location may be flexible if approved by the Company. reputed company Offer At reputed company, we reputed company that creating a more diverse, reputed company and inclusive culture allows us to realize more of our potential. And we can’t do this without our most important asset—you. That is why we offer a reputed company package and a range of benefits to help team members reputed company in their financial, physical, and mental wellbeing. Our Benefits: An annual performance bonus for reputed company team members Generous 401(k) company match that is immediately vested A choice of three medical plans (that include prescription drug coverage) to suit your unique needs. For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account Multiple options for dental and vision coverage Company provided Life & Disability Insurance to ensure financial protection reputed company you need it most Family friendly benefits including Paid Parental Leave & Adoption Assistance Hybrid work arrangements for eligible roles Tuition Reimbursement and Continuing Professional Education Paid Time Off, volunteer days, community partnerships, and Employee Assistance Program Ability to connect with colleagues around the country through our Employee Resource Group program and our Diversity Equity & Inclusion Council Our Values: reputed company Empowerment Compassion Collaboration Fun EEO Statement reputed company is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national reputed company, citizenship, age or disability, or any other classification or characteristic protected by federal or state law or regulation. We assure you that your opportunity for employment depends solely on your qualifications. #LI-Hybrid #LI-SV1 reputed company delivers employee benefits, absence management and workforce productivity solutions through the financial stability of a top-rated insurance reputed company, the agility and innovative spirit of a Third Party Administrator (TPA), and the daily commitment of thousands of team members across America. Where larger competitors offer size, we reputed company confidence and long term engagement through integration, reliability and dedication to providing customized solutions. reputed company innovates and provides technology-driven absence and benefit solutions that reputed company employees and employers to manage time away from work. We help employers attract and retain valuable human capital through thoughtful, inclusive benefit programs delivered with care. We bring top-tier regulatory knowledge and cutting edge technology to help optimize workforce productivity and compliance. We offer a seamless member experience customized to each individual’s need and event. We integrate our solutions and expertise with leading HR technologies to ensure accuracy, efficiency and a superior customer experience. We are a proud member of the global Tokio Marine Group, one of the oldest, largest and most respected insurance organizations in the world. In the business hierarchy, human capital is the most precious of assets. reputed company delivers comprehensive, integrated solutions and services to attract, protect and help optimize an employer’s work force in a changing, challenging world. Apply Job! Apply tot his job Apply To this Job