U.S. Department of Labor

Claims Examiner I

U.S. Department of Labor

full-time

Posted on:

Location Type: Remote

Location: United States

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About the role

  • Under general supervision, assesses claim information, references contracts and performs calculations and other functions to accomplish the processing and payment of insurance claims of a complicated or non-routine nature.
  • Interprets contract information and communicates with outside parties to obtain information and coordinate coverage.
  • Performs claim research and adjustments.
  • Successfully completes all training programs as required for the level.
  • Processes claims for two products or claim types (dental, hospital, medical, ITS, FEP).
  • Performs research and adjustment functions for claims.
  • Perform special projects (e.g., complex accumulator reconsiderations, New Directions).
  • Responds to written inquiries from internal and external customers as business needs dictate.
  • Sets up deducts, CLOV table entries, and other assigned finance functions.
  • For FEP positions, processes all deferrals for FEP or edit corrections in computerized claims system.
  • Performs complex FEP transactions (e.g., FEP Direct DDE, FEP Retro-enrollment, Out of Balance) and member appeals.

Requirements

  • High school diploma or general education degree (GED)
  • 2 years of previous customer service, member services, or claims processing experience; or any combination of required education and experience.
  • Advanced Keyboarding Knowledge
  • Intermediate knowledge of Microsoft Office
  • Knowledge of FACETS and/or other computerized claims processing system as applicable (FEP).
  • Associates degree from college or technical school
Benefits
  • Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
  • Annual incentive bonus plan based on company achievement of goals
  • Time away from work including paid holidays, paid time off and volunteer time off
  • Professional development courses, mentorship opportunities, and tuition reimbursement program
  • Paid parental leave and adoption leave with adoption financial assistance
  • Employee discount program
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
claims processingcalculationscontract interpretationclaim researchadjustmentsadvanced keyboardingMicrosoft OfficeFACETSFEP transactionsdeduct setup
Soft Skills
communicationcustomer serviceproblem-solvingorganizational skillsattention to detail
Certifications
high school diplomaGEDassociates degree