This position is responsible for examining routine and non-routine claims for one or more products and multiple series of contracts by evaluating the extent of liability within established guidelines. This position is accountable for analyzing claims to determine benefit/contract eligibility and processing claim transactions within specified dollars limits in compliance with state and federal regulatory standards, and NAIC (National Association of Insurance Commissioners) guidelines. Additionally, this position is a member of a team, actively partners with peers on meeting established service and quality standards, provides coaching and training to other Examiners and identifies opportunities for process improvements.
Job Duties and Responsibilities- Determine extent of liability on routine and non-routine claims and make final claim decisions within specified dollar limits. Contribute to accurate fraud detection and reporting by referring suspected fraud to appropriate staff for review according to established procedures.
- Analyze claim transactions and process payments utilizing various work flow, administrative, and LOB (Line of Business) systems, accurately and cost effectively according to contract provisions and in compliance with internal service and state and federal regulatory standards.
- Ensure high level of customer satisfaction by partnering with members, financial associates, doctors, providers, attorneys, police, vendors and other internal and external customers regarding claims, settlements and interpretation of policy provisions, which may include highly confidential information or complaints, often educating the recipient on products/benefits and regulatory requirements.
- Handle sensitive written and verbal communications. May be called upon to influence behavior via these communications.
- Actively participate in the development and implementation of business processes, standard operating procedures, documentation and other support materials required for unit operation. May also analyze data and offer remediation in response to audit inquiries or compliance examinations as determined by the Claims Consultant.
- Provide consultation to Associate Claims Examiners in helping to answer questions and make decisions on claims with a moderate level of complexity.
Required Job Qualifications- High school required. College degree preferred.
- Minimum of 2 years relevant experience.
- Professional credentials preferred (e.g. LOMA, ICA).
- Intermediate knowledge of claim administration and operations as well as pertinent laws and regulations.
- Must possess strong interpersonal skills, as well as excellent verbal and written communication skills.
Other Critical Factors- As part of Thrivent Financial's hiring process, a verification of a candidate's background will be made to complete the hiring process.
- May represent the company at depositions and court appearances.
Pay TransparencyThrivent’s long-term growth depends on attracting, rewarding, and retaining people who are committed to helping others thrive with purpose. We accomplish this by offering a wide variety of market competitive compensation programs to attract, reward, and retain top talent. The applicable salary or hourly wage range for this full-time role is $24.06 - $32.56 per hour, which factors in various geographic regions. The base pay actually offered will be determined by a variety of factors including, but not limited to, location, relevant experience, skills, and knowledge, business needs, market demand, and other factors Thrivent deems important.Thrivent is unique in our commitment to helping people to be wise with money and live balanced and generous lives. That extends to our benefits.The following benefits may be offered: various bonuses (including, for example, annual or long-term incentives); medical, dental, and vision insurance; health savings account; flexible spending account; 401k; pension; life and accidental death and dismemberment insurance; disability insurance; supplemental protection insurance; 20 days of Paid Time Off each year; Sick and Safe Time; 10 paid company holidays; Volunteer Time Off; paid parental leave; EAP; well-being benefits, and other employee benefits. Eligibility for receipt of these benefits is subject to the applicable plan/policy documents. Thrivent’s plans/policies are subject to change at any time at Thrivent’s discretion.
Thrivent provides Equal Employment Opportunity (EEO) without regard to race, religion, color, sex, gender identity, sexual orientation, pregnancy, national origin, age, disability, marital status, citizenship status, military or veteran status,genetic information, or any otherstatus protected by applicable local, state, or federal law. This policy applies to all employees and job applicants.
Thrivent is committed to providing reasonable accommodation to individuals with disabilities. If you need a reasonable accommodation, please let us know by sending an email to human.resources@thrivent.com or call 800-847-4836 and request Human Resources.
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Originally posted on Himalayas