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Security Financial
Claims Analyst ISecurity Financial • Lincoln, NE, United States
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Claims Analyst I

Claims Analyst I

Security Financial • Lincoln, NE, United States
20 days ago
Job type
  • Full-time
Job description

Job Title

Assurity is looking for enthusiastic, driven and collaborative people to join our team. We're a company of vibrant and passionate people who work every day to advance our mission of helping people through difficult times and who truly want to make a difference. As a Certified B Corporation, we have a verified commitment to our people, community and planet, and we work every day to make the world a better place. Ample opportunities for growth, a thriving culture and coworkers who care as much as you do are just the beginning. Come work with purpose.

Essential Functions

85% Process health claims, which may include:

  • Initializing and triaging all claims for all health and disability products;
  • Independently examine claims documentation such as medical bills/records, accident reports, claim forms and facility information (HCFA 1500 & UB04) and validate claims against policy coverage, state/federal regulations, and contractual requirements to determine correct claim process and decision;
  • Serve as a liaison between numerous internal departments, including but not limited to customer service, accounting, legal, and others;
  • Adhere to all statutory and regulatory fair claims practices;
  • Making judgments within the standards of completeness, timeliness and accuracy regarding payment, denial, or investigation;
  • Reading and analyzing medical records;
  • Understanding and applying policy provisions;
  • Composing and typing correspondence to policy holders, doctors, employers, and others as required;
  • Calling claimants and/or employers for additional information;
  • Ordering investigative reports, medical, financial, and other records as required;
  • Paying ongoing/continuance claims within authority level;
  • Referring continuance claims after 3 months of benefits have been paid to higher level; and
  • Processing continuance claims when referred back from higher level.

5% Refers specified non-routine cases to team lead(s), Sr. Claims Supervisor, or higher level analysts.

10% Performs other functions as assigned, which may include:

  • Answering calls referred from Contact Center;
  • Helping train new associates.

The list of essential functions is not exhaustive and may be substituted as necessary.

Experience and Skill Requirements

  • Four to six years' relevant experience or equivalent required.
  • Professional oral and written communication skills required.
  • Consistent and reliable attendance is an essential function to this position.
  • Decision-making ability required.
  • Proficiency with word processing and spreadsheet software.
  • Progress toward completion of ALHC and FLMI designations.
  • Problem solving skills and appreciation for details required.
  • Knowledge of LifePro and Workflow systems.
  • Talent required in values, work intensity, achiever, positivity, resourcefulness, command, persuasion, relationship-extension, and exactness.

Education and Certification Requirements

  • Associate degree or equivalent in business or related field required.

Physical and Work Schedule Requirements

  • May require work in excess of 40 hours a week in order to complete functions of position.
  • Hybrid position based in Lincoln, NE. Requires three days per week onsite and provides a hybrid schedule with two remote workdays.
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Claims Analyst I • Lincoln, NE, United States

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