Claims Examiner

Company: Ameritas
Location: San Antonio
Posted on: July 22, 2021

Job Description:

At Ameritas, our mission is Fulfilling Life. We do that in many ways, but especially by helping people invest in themselves by offering trusted financial products and advice. Because we believe everyone should be happy, healthy and financially secure, we work hard to provide trusted financial products and valued guidance, including individual life and disability insurance, employee benefits, retirement planning, investments, and wealth management services.

Ameritas Life Insurance Corp is seeking a Claims Examiner to drive the business by processing claims in accordance with the specific policy and/or processing arrangements through the application of "Best Practices". Communicate with providers and insureds to professionally evaluate claims or related materials.

What you do

* Review and provide resolution for claims rejected by the auto-adjudication process in accordance with the departmental accuracy and responsiveness standards using the claims/image system and various sub-systems. * Recognize procedure codes, tooth numbers, etc. and understand how they interrelate to ensure claims for all products were processed appropriately. (Functions will include claims processes for all products - dental, vision and hearing products.) * Resolve inquiries and problems and arrive at a quick, accurate and satisfactory resolution. Manually process claim re-submissions. * Knowledge of various contracts and marketing arrangements including PPO contracts and service guarantees. Interpretation of coordination of benefits and other policy provisions, company practices and transition guidelines. * Apply policy provisions and knowledge of company philosophy to ensure compliance with the contract, legal requirements and guidelines established by various states' regulations. * Provide second review of claims. * Work the front desk, either as primary, back-up, or as part of a rotation with other associates. * Back-up the Group Support Specialist in San Antonio as directed by management. * Ability to work periods of overtime as required based upon business need.

What you bring

* Experience in a dental related field or claim processing environment helpful. * Ability to work independently and handle multiple duties. * Problem solving and analytical skills. * Organizational skills. * Must possess good grammar in speaking and writing; should have good verbal skills in formal and informal business settings, and be able to write clearly. * Focused on continuing educational development opportunities. * Proficient use of personal computer system and keyboarding skills. * Ability to maintain current knowledge of claims/image system, all procedure codes, and customer service standards; as well as the diverse components in the various products, marketing arrangements and panel leasing arrangements. * Ability to appropriately apply the Coordination of Benefits provision with respect to other dental carriers, pre-paid carriers, medical insurers, individual coverage and other entities in which duplication of benefits may be provided. * Ability to effectively utilize multiple mainframe business systems. * Ability to quickly adapt to new procedures and job functions derived from changes in laws and business relationships. * Ability & willingness to work positively in a Team environment.

What we offer

* $850 retention bonus * $14.18/ hour pay * Our company motto is "Fulfilling Life" and we take that job seriously, with a heavy commitment to volunteering and community support, employee well-being, and providing quality products and services that help our customers create a brighter future. * Being a mutual-based organization, the return on our investment goes back into the company, to benefit our members/customers. * We're committed to professional development, opportunity, inclusion and diversity. Team building and collaboration are also priorities. * A total rewards package with all the comprehensive health and welfare benefits you'd expect, including competitive pay and incentives, 401(k), flexible work schedules and time off to care for yourself and others. * Additional popular benefits, including tuition reimbursement, and student loan repayment, an incentivized well-being program, adoption assistance, paid time off for volunteering, training and career development opportunities.

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Keywords: Ameritas, San Antonio , Claims Examiner, Other , San Antonio, Texas