Claims Examiner – Long Term Care
Thrivent
full-time
Posted on:
Location Type: Remote
Location: Minnesota • United States
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Salary
💰 $24 - $33 per hour
About the role
- Determine extent of liability on routine and non-routine claims and make final claim decisions within specified dollar limits.
- Contribute to accurate fraud detection and reporting by referring suspected fraud to appropriate staff for review according to established procedures.
- Analyze claim transactions and process payments utilizing various work flow, administrative, and LOB (Line of Business) systems, accurately and cost effectively according to contract provisions and in compliance with internal service and state and federal regulatory standards.
- Ensure high level of customer satisfaction by partnering with members, financial associates, doctors, providers, attorneys, police, vendors and other internal and external customers regarding claims, settlements and interpretation of policy provisions, which may include highly confidential information or complaints, often educating the recipient on products/benefits and regulatory requirements.
- Handle sensitive written and verbal communications.
- Actively participate in the development and implementation of business processes, standard operating procedures, documentation and other support materials required for unit operation.
- Provide consultation to Associate Claims Examiners in helping to answer questions and make decisions on claims with a moderate level of complexity.
Requirements
- High school required
- College degree preferred
- Minimum of 2 years relevant experience
- Professional credentials preferred (e.g. LOMA, ICA)
- Intermediate knowledge of claim administration and operations as well as pertinent laws and regulations
- Must possess strong interpersonal skills, as well as excellent verbal and written communication skills.
Benefits
- various bonuses (including, for example, annual or long-term incentives)
- medical, dental, and vision insurance
- health savings account
- flexible spending account
- 401k
- pension
- life and accidental death and dismemberment insurance
- disability insurance
- supplemental protection insurance
- 20 days of Paid Time Off each year
- Sick and Safe Time
- 10 paid company holidays
- Volunteer Time Off
- paid parental leave
- EAP
- well-being benefits
- other employee benefits
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claim administrationfraud detectionclaim analysispayment processingregulatory compliancebusiness process developmentstandard operating proceduresdocumentationconsultation
Soft skills
interpersonal skillsverbal communicationwritten communicationcustomer satisfactioneducationproblem-solving
Certifications
LOMAICA