Claims Examiner

Posted on Sep 7 San Antonio, TX

Ameritas Life Insurance Corp

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 will get to do in this position:

  • 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.
  • Provide support to the contact center by answering customers' inquiries via phone, and have an understanding of the phone system.

Ameritas offers a comprehensive benefit package to all associates, including:

  • PPO Health Insurance Plans
  • HSA & employer contributions
  • Dental and Vision coverage (including Lasik and Hearing Care benefits)
  • Paid parental/elder care leave
  • Flexible paid time off (PTO)
  • Paid Community Service/Volunteer Leave