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Claim Analyst
Mutual of Omaha
Waverly, NE, United States
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Essential Job Functions:
• Accurately determines complex 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.
• Analyzes complex claims documentation and correspondence in order to process claim transactions, and assists with customer requests to determine appropriate outcomes. Keys and documents data accurately.
• Communicates with external and internal customers to obtain specific claim information in order to finalize claims and to explain claim handling.
• Receives, analyzes and processes incoming claim inquiries and communicates outcomes. Effectively responds to and resolves customer requests by utilizing expanded knowledge and skill sets, systems, policies, procedures, regulations, and other reference available. May handle escalated claim and call requests.
• Provides effective customer service via multiple channels on the phone (to include inbound and outbound calls), written/email, correspondence, etc. Performs service recovery techniques to resolve requests. Provides compliant and easily understood resolution options with the desired outcome of creating a positive customer experience. Utilizes resources to support service delivery resulting in retaining and/or growing the business.
• Meets and/or exceeds department standards related to attendance, productivity and quality
• Makes appropriate referrals to legal, underwriting and special investigations as needed.
• Creates written letters to provide concise explanations to customers regarding claim determinations.
• Actively participates in and seeks out self-development opportunities, exposures and experiences, with a willingness to learn new skills and/or product lines.
• Actively participates in daily management through huddle involvement and the identification and supports implementation of process improvements. Provides insights and recommendations of for enhancements to processes, training and the quality of service delivery to our customers.
• Has a primary focus on customer satisfaction, provides an effective level of customer service.
• Stays abreast of and adheres to Company processes and procedures, industry changes, federal and state legislation and regulations.
• Assists with peer development and delivery/service requirements through information and knowledge sharing, resulting in supporting and resolving customer requests. Assists with the development, delivery and oversight of training and quality auditing program material.
• Develops and maintains effective working relationships with internal and external customers.
• May handle over limit threshold payment approvals based on department guidelines.
• This position requires extensive or prolonged typing/keyboarding.
• This position is in a fast-paced, high volume environment with set production goals.
• This position requires sitting over 66% of the time.
• This position requires Visual Acuity at 20 inches (or less) over 66% of the time.
Minimum Qualifications:
• Shows a sense of urgency and is accountable for work results.
• Demonstrated ability to adapt to a diverse and changing work environment. Willingness to learn new skills with the ability to multi-task.
• Ability to work independently, and/or as part of a team, in a collaborative environment and is approachable.
• Effective time management and organizational skills with an attention to detail and strong analytical and decision-making abilities.
• Ability to meet deadlines in a fast paced work environment.
• Strong oral, written and interpersonal communication skills, sound judgment and the ability to think within a structured and compliant work environment while focusing on the customer.
• Demonstrated understanding of computer systems such as email, data entry, and Microsoft products, with proficient keyboarding skills.
• Ability to work flexible shifts and maintain regular and predictable attendance with adherence to department and company attendance expectations. May be required to work overtime based on business needs.
• Demonstrated ability to assess and understand the needs of the customer and demonstrates flexibility in customizing approach and response to resolve requests in a respectful and timely manner.
• Ability to diffuse escalated situations when necessary.
Preferred Qualifications:
• Working knowledge/experience in Cancer-Hospital claims.
• College degree or work equivalent.
• Insurance product knowledge of Business area.
• Experience with the application of policies, practices and procedures in a business environment.
• Knowledge of medical terminology.
• Presentation skills.
Mutual of Omaha and its affiliates are an Equal Opportunity /Affirmative Action Employer, Minorities/Female/Disabled/Veteran
To All Recruitment Agencies: We do not accept unsolicited agency resumes and we are not responsible for any fees related to unsolicited resumes.