New

Claims Remediation Clerk

TEKsystems
$21.00 - $25.00 / hr
life insurance, sick time, short term disability, long term disability, 401(k), retirement plan
United States, Texas, Amarillo
Jan 09, 2025
Description Responsible for examining and processing all claim types including short term or long term disability, life, waiver of premium, critical illness, accident insurance and other claim type for various policies. Job Responsibilities: Assume responsibility for all assigned large accounts and sensitive groups to review and resolve customer problems and complaints concerning claims matters and personally handles the claim through resolution. Proactively communicate and respond to claim inquiries from insureds, beneficiaries, policyholders and internal stakeholders; resolve issues through effective verbal and written communication by involving appropriate people within, or outside the department or company; effectively and professionally represent the company in all interactions. Investigate, research, verify and diligently obtains medical information on all claim types to determine eligibility and interpret information relating to the severity of the stated disability or incident. Adjudicate claims in accordance with established policies and procedures. Interview, make calls and/or corresponds with customers to determine extent of customer concern and resolves situation in accordance with standard operating procedures. Proactively identify inconsistencies or lag in claim information and utilize effective approaches and resources to obtain clarification or verification. Approve or deny claims within policy limits; recommend approval, denial, rescission or settlement of disputed claims. Assist in the preparation of grievance summaries and information for lawsuits. Skills & Qualifications Required Job Qualifications: Bachelor degree or 4 years of business experience. 2 years of claims experience. Must have experience with adjudicating Accidental, Critical, Hospital or Short term Disability claims Problem solving and research skills. PC proficiency to include Word, Excel, PowerPoint, Outlook and Lotus Notes. Proficient in the following: Correspondence, Medical Records Review, Misrepresentation Investigation, Pre-Existing Investigation, Evidence of Insurability Review, Benefit Entitlement Review, Financial Accuracy, ERISA Guidelines, MAR Requirements, State Regulations, Contract Language, Company Financial Liability. Experience in the following core systems: ECM, STAR (Claim System), Genelco/GIAS, Siebel, UTS, Casetrak, Docsql, Benefits Manager, and ImagePlus. Experience processing one (1) of the following claim types: Life or Waiver of Premium claims. Experience in processing any of the following two (2) claim types: Critical Illness/Specified Disease, Accidental Insurance, GAP, Permanent and Total Disability (PTD benefits, Accidental Death and Dismemberment, Permanent and Total Disability (PTD), Accelerated Death Benefits. Preferred Job Qualifications: LOMA courses. Aptitude for math and critical thinking skills. Knowledge of state regulations, statutes, and ERISA. Detailed oriented. Hours: M-F, 8:00am - 5pm *Hybrid - Can sit out of local offices in Lombard, IL, Richardson, TX, or Amarillo, TX Pay and Benefits* The pay range for this position is $21.00 - $25.00 Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a hybrid position in Amarillo,TX. Application Deadline This position will be accepting applications until Jan 18, 2025. About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.