Job Description
Its the new age of independence. And its changing the way we live.BE PART OF IT.
UNIVITA is dedicated to helping people live and age with independence. By providing a single place to find and manage resources which support independent living, UNIVITA makes it easier to access care and to age safely at home.
This is your opportunity to join an innovative company with a culture that promotes compassion, trust and accountability.
ABOUT THIS OPPORTUNITY In this position, you will play a critical role adjudicating routine Home Care and Facility based claims for Long Term Care (LTC) products as well as assist the Customer Service team with claims related calls.
Position Title: Claims Intake Examiner II
RESPONSIBILITIES
- Interpret and apply fundamental policy language to claim scenarios.
- Develop and expand knowledge of all LTC policy forms and procedures.
- Perform investigations and research standard claims including obtaining proof of loss and escalate cases that are in need of investigation.
- Determine if government services are available for the individual and learn what services are in place to prevent conflicts with contractual language.
- Apply knowledge concerning state and federal regulations of health care industry, government-funded programs and private insurance.
- Process selected claims reimbursement request following all guidelines and procedures
- Review and assign all Customer Service Inquires (CSI) request to off-shore partners
- Complete claim verifications on outstanding requirements for reimbursement of benefits
- Review and process all claim correspondence including Escheatment Payee letters
- Assist off-shore partners with question or clarification relating to policy language and requirements
- Process all claim payment reissue request
- Assist with the review of process controls relating to claim payments, waiver of premium, etc.
Job Requirements
- High school diploma required; Bachelors degree or equivalent work experience preferred
- 1+ years work experience in processing health, long-term care or disability claims strongly preferred
- 1+ years experience in claims adjudication with medical or life claims required
- Previous experience in a medical or insurance related call center environment required; 1+ year preferred
- Knowledge of nursing home, home care service providers and service delivery settings preferred
- Knowledge with a personal computer and Microsoft products
- Data entry skills and is proficient with figures and calculations
- Detail-oriented, creative problem solver and strong organizational skills
- Excellent verbal and written communication skills
- Excellent interpersonal and customer service skills
Univita offers a competitive and complete benefits package.
TO LEARN MORE ABOUT US visit univitahealth.com (EOE/AAE m/f/d/v)
Key Words: Claims, Claims Processing, Health, Healthcare, Care, Quality Assurance, QA
Country: USA, State: Tennessee, City: Nashville, Company: Univita.
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