Claims Examiner at ManhattanLife

Salt Lake City, Utah, United States -

Full Time

Start Date

Immediate

Expiry Date

29 May, 26

Salary

0.0

Posted On

28 Feb, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Review, Data Entry, Customer Service, Claims Processing, Benefit Determination, Communication, Interpersonal Skills, Decision Making, Dependability, Flexibility, Computer Literacy, Microsoft Word, Microsoft Excel, Records Management, Typing Speed

Industry

Insurance

Description

Who we are: ManhattanLife Insurance and Annuity Company was founded in 1850, the Company’s longevity makes it one of the oldest and most reliable health and life insurance companies in the country. Operating successfully for over 175 years is a testimony to ManhattanLife’s enduring history, and an indicator of the reliability of our future. ManhattanLife’s headquarters are in Houston, TX and the company is continually growing with multiple office locations nation-wide. ManhattanLife offers attractive employee benefits starting day one, including immediate coverage under our health, dental and vision plans. We offer flexible schedules, including shortened hours on Fridays, free parking, company-wide events, professional development (LOMA testing) and a company-wide wellness program. Scope and Purpose: ManhattanLife is seeking a Claims Examiner to support our organization’s Utah team. Claims Examiners evaluate medical claims submissions, process the claims on our systems, and ensure data is entered into our system while keeping data up to date. Our Claims Processors also provide customer service to our policyholders over the phone. Duties and Responsibilities: * Review, reprice, and pay claims. * Daily data entry of all claims for Medical, Home Health Care Prescription (HHC RX), Student Accident (SA), Cancer (CA), and Accident (AC) claims. * Make customer service calls. * Handle connections assigned. * Follow up on all pending claims. * Send out all claim forms related to Health, SA, CA, AC, HHC, HHC RX. * Process returned mail. * Send out explanation of benefits (EOB) to providers. * Remain aware of any product system modifications and enhancements along with any procedural changes. * Collaborate, coordinate, and communicate with departments within the company to ensure constant sharing of information and quality of service for our customers. * Accurately determine claim benefits payable based on medical records, contract language, and any additional information needed to reach the appropriate decision in a timely manner. This includes both payment and denial of benefits. * Complete special projects and tasks as assigned by management. Minimum Qualifications: High School Graduate or equivalent (GED); one year of business experience; insurance knowledge preferred. Type a minimum of 45 words per minute. Knowledge, Skills and Abilities: * Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community. * Ability to make procedural decisions and judgements on sensitive, confidential issues. * Ability to attentively take direction and execute tasks and changes from management for all processes and operations. * Dependable and flexible. * Computer literate; demonstrates proficiency in the use of Microsoft Word and Excel. * Strong data and records management skills. Travel Requirements: Travel is not anticipated for this position. PROFESSIONAL DEVELOPMENT: * Establish annual objectives for professional growth. * Keep pace with developments in the discipline. * Learn and apply technologies that support professional and personal growth. * Participate in the evaluation process. * Ability to attentively take direction and execute tasks and changes from management for all processes and operations. PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee is regularly required to stand; walk; use hands to finger, handle or feel objects, type, and use mouse; reach with hands and arms and talk and/or hear. The employee is required to sit for extended periods of time. The position may require lifting, pulling or moving items weighing upwards of 10 pounds as it relates to office or desk supplies. WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee regularly works in an office environment. This role routinely uses standard office equipment such as computers, phones via WebEx, physical phone while in office, and photocopiers when necessary. OTHER DUTIES: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to the job at any time without notice. AAP/EEO STATEMENT: ManhattanLife prohibits discrimination based on race, religion, gender, national origin, age, disability, veteran status, marital status, pregnancy, gender expression or identity, sexual orientation, or any other legally protected status. EOE Employer/Vet/Disabled. ManhattanLife values differences. We are committed to fostering an environment that attracts and retains a diverse workforce. With individuals from a variety of backgrounds, ManhattanLife will be better equipped to service our customers, increase innovation, and reduce risks. We encourage the unique perspectives of individuals and are dedicated to creating a respectful and inclusive work environment.

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Responsibilities

Claims Examiners will evaluate medical claims submissions, process them on company systems, ensure accurate data entry, and provide customer service support to policyholders via phone. Duties include reviewing, repricing, and paying various types of claims while following up on pending cases and sending out necessary documentation like Explanation of Benefits.