Senior Associate Claims Examiner
DXC Technology
Melbourne, Victoria , Australia
1d ago

Job Description :

Essential Job Functions

  • Conducts correspondence related to client requests for information.
  • Evaluates available information to validate claims. Verifies policyholder information, policy effective dates, premium status and verification of claim eligibility.
  • Identifies need for additional information; contacts appropriate source to obtain needed information. Verifies beneficiary or claimant information if claim is warranted.
  • Identifies payment amount and obtains required management approvals for payment. Processes payment.

  • Investigates highly complex claims and determines level of resolution if appropriate; advises claimant of status; negotiates settlement and resolution of claim.
  • Receives demand letters; researches and investigates claims, responds within individual parameters and escalates as appropriate.
  • Schedules work and monitors work performance, including production and quality standards, of lower level claims examiners, as needed.
  • Provides leadership and work guidance to less experienced personnel to ensure accuracy and timeliness of processing. Recommends personnel actions to management and may participate in performance evaluations or counseling employees.

  • Assists in claims financial reporting and reconciliation for client companies.
  • Basic Qualifications

  • High school diploma or G.E.D.
  • Fellowship of Life Health Claims (FLHC) Certification preferred
  • Six or more years of insurance / claims processing experience
  • Experience working with insurance and / or medical terminology
  • Experience working with appropriate claims processing procedures and documentation
  • Other Qualifications

  • Strong analytical and problem solving skills
  • Strong interpersonal skills to interact with team members
  • Strong communication skills to communicate with clients
  • Strong negotiation skills to interact with claimant
  • Good human relations skills to provide leadership and work guidance to less experienced personnel
  • Ability to keep sensitive and confidential material private
  • Ability to work in a team environment
  • Work Environment

  • Office environment
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