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Insurance Claims Examiner

3+ months agoSan Antonio, TX

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Operations is one of four services that make up one Accenture -the others are Strategy and Consulting, Interactive and Technology.

Job Description

The Voluntary Benefits Claims Examiner Analyst will support a large Group Insurance Business contract is responsible for the calculation of Voluntary Benefits according to Plan Provisions. This position requires the knowledge and understanding of Voluntary Benefits policies and procedures to appropriately calculate the benefits due. You will be expected to follow through timely on plans, utilize judgment, and assess risk when rendering claim decisions. Able to communicate with various constituents with limited guidance and learn and transact using the client s systems. Expected to communicate clearly concisely to influence return to work, discuss terms of the certificate, and the basis of payment nonpayment.

Responsibilities include:
  • Document all claim information including phone calls and correspondence
  • Utilize effective communication to obtain information both verbally and in writing and provide information to the claimant and employer
  • Ability to apply plan provisions understand the needs of the clients
  • Expected to adhere to client Service Level Agreements and department s product s key performance requirements and any reporting
  • Able to utilize strong organizational skills to manage multiple priorities while working under tight time constraints, possess the ability to work through ambiguity, and work effectively with various vendors with strong interpersonal skills
  • Willing to support special internal functional projects and ad hoc requests as required.
  • Able to work cohesively with Subject Matter experts to support the day to day tasks, able to anticipate, identify, and resolve complex issues problems.
  • Able to communicate risks issues to supervisor and help with the resolution, as needed
  • Provide exceptional customer service either over the phone or through email
  • Able to provide leadership updates progress reports on training curriculum
  • Utilize tools independently and accurately to identify work to be completed
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Basic Qualifications
  • Minimum of 1 year experience in Insurance Claims Processing
  • Minimum of 2 years experience in a contact center/call center
Preferred Qualifications
  • Group Life/Disability Claims experience
  • Bachelor s Degree
  • NY Adjustor License
  • Proficiency in Windows environment, including Word and Excel
  • Strong mathematical skills
Professional Skills
  • Strong written and verbal communications required
  • Detailed oriented with strong time management skills
  • Work hour flexibility 7 am to 7 pm CST
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Job ID: AccentureInc-R00031177
Employment Type: Other