Claims Examiner Claims Examiner …

Capgemini
in Pensacola, FL, United States
Permanent, Full time
Be the first to apply
Competitive
Capgemini
in Pensacola, FL, United States
Permanent, Full time
Be the first to apply
Competitive
Claims Examiner
LTC Claims Examiner

ob Title:                Claims Examiner

Department:         CNA

Reports To:          Margaret Mills-Klima

FLSA Status:        Non-Exempt:       

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.

  • Responsible for accurate/timely daily review of Long-Term Care claims and policy provisions to process payment or issue denial.  This role does not involve full claim handling from claim receipt or intake to closure.  In terms of claims handling, this position is specifically limited to the payment or adjudication of invoices pertaining to long term care claims.
  • Responsible for the identification, analysis and application of long-term care claim product features including waiver of premium, waiting period, assignment of benefits, credits, and other applicable policy benefits.
  • Meet or exceed minimum production and quality targets as approved by management.  
  • Respond accurately, timely and professionally to all oral and written external and/or internal correspondences received from stakeholders in regard to benefits, eligibility, claim payments, denials and/or explanation of benefits. As well as inbound claim calls.
  • Maintain working knowledge of all company services pertaining to business segment, company claims, administrative and imaging software systems such as INSPRO and Microsoft applications
  • Operate within company regulations regarding HIPAA, fraud, confidentiality, and private health information guidelines.
  • Other duties as assigned.

SKILLS AND ABILITIES

  • Experience with Microsoft Word, Excel and Outlook.
  • Willingness to work various schedules and adapt to a changing work environment.
  • Strong communication skills verbal and written.
  • Ability to disseminate and learn information in a short period of time. 
  • Efficient and accurate use of technology for data entry, documentation, and analysis.
  • The ability to multi-task and quickly navigate multiple business tools while maintaining quality.
  • Proven ability to meet deadlines.
  • Ability to make a positive contribution as demonstrated by learning new skills and making suggestions for process/procedure improvement.
  • Maintain client and company quality and production standards.
  • Maintain knowledge of applicable company policies and procedures.

QUALIFICATIONS 

To perform this job successfully, the individual must be able to perform each essential duty effectively.  The individual must possess advance product knowledge, comprehensive understanding of insurance terminology and definitions, core knowledge of company and department processes and procedures related to the ability to complete job responsibilities /duties in a proficient and professional manner. 

EDUCATION and/or EXPERIENCE

One to Two years certificate/degree from college or technical school preferred.

One or more years of claims processing experience within a claims operation.

LANGUAGE SKILLS

Must have the ability to read and interpret documents such as policies and operating and procedural manuals; Ability to write routine correspondence; Ability to speak effectively to customers, clients or employees of the organization. 

MATHEMATICAL SKILLS

Must have the ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals; Ability to calculate figures and amounts such as discounts, interest, and

percentages.

REASONING ABILITY

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form; Ability to deal with problems involving several concrete variables in standardized situations.

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 be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit.  The employee frequently is required to use hands to finger, handle, or feel.  The employee is occasionally required to reach with hands and arms and talk or hear.  Specific vision abilities required by this job include close vision, and ability to adjust focus.

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 the essential functions.

Work environment is in office.  The noise level in the work environment is usually low to moderate. 

Candidates should be flexible / willing to work across this delivery landscape which includes and not limited to Agile Applications Development, Support and Deployment.

About Capgemini:

Capgemini is a global leader in consulting, digital transformation, technology and engineering  services. The Group is at the forefront of innovation to address the entire breadth of clients opportunities in the evolving world of cloud, digital and platforms. Building on its strong 50-year+ heritage and deep industry-specific expertise, Capgemini enables organizations to realize their business ambitions through an array of services from strategy to operations. Capgemini is driven by the conviction that the business value of technology comes from and through people. Today, it is a multicultural company of 270,000 team members in almost 50 countries. With Altran, the Group reported 2019 combined revenues of 17billion.

Visit us at . People matter, results count.
Primary Location: US-FL-Pensacola
Work Locations:
Job: Programmer/Analyst
Organization: Capgemini Global
Schedule: Full-time
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