Phone Claim Analyst (Supplemental Health) [United States]

 

Location: Various Locations
Work Type: Full Time Regular
Job No: 502311
Categories: Customer Service, Claims/Claims Processing

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Application Closes: Open Until Filled

Ensures the accurate, prompt, and thorough evaluation of claims by analyzing and determining the appropriate action steps needed while adhering to both internal and external regulations and ensuring an industry leading customer experience.

Requires independent decision making on claims situations using some critical thinking. Claim analysis includes: eligibility determination for benefits based on information received, contract analysis, customer service, fraud detection and awareness, some financial calculations, interpreting information and adhering to all statutory/governmental regulations. This includes analyzing information received, and determining if additional information is needed to make an accurate benefits decision.

Embraces the customer-focused strategy and demonstrates our shared values (Customer Focus, Integrity, Innovation, Accountability, and Collaboration) by providing effective customer service resulting in first request resolution and a positive customer experience.

Interacts, responds and resolves customer claim requests via multiple channels which may include phone, email and written correspondence. Performs multiple work roles with basic knowledge and skill sets such as data entry, processing basic claim transactions and handling common customer requests under minimal supervision.

Training will be up to 6 weeks Monday - Friday from 8am - 4:30pm CST.

The hours after training will be Monday - Thursday from 9am - 5:30pm CST and Fridays from 8:30am - 5pm CST.

WHAT YOU'LL DO:

• Accurately determines claim benefits payable based on medical information and contract language in a timely and accurate manner.
• Reviews and analyzes provider information to identify changes, additions and deletions. Verify all information conforms to established policies and procedures; ensure that provider data adheres to Corporate guidelines for file integrity and reporting purposes while maintaining production, quality and time service standards.
• Analyzes claims documentation and correspondence in order to process claim transactions, or assists with customer requests to determine appropriate outcomes. Keys and documents data accurately.
• Communicates with external and internal customers to obtain specific claim information in order to finalize claims and to explain claim handling.
• Communicate with providers and internal departments to provide information in reconciling conflicting Tax Identification Number (TIN) and/or Legal Name responses.
• Reviews and analyzes provider information to identify changes, additions and deletions. Verify all information conforms to established policies and procedures; ensure that provider data adheres to Corporate guidelines for file integrity and reporting purposes while maintaining production, quality and time service standards.
• Receives, analyzes and processes routine incoming claim inquires, and communicates outcomes. Effectively responds to and resolves customer requests by utilizing knowledge and skill sets, systems, policies, procedures, regulations and other reference materials.
• Identifies and investigates potential providers to ensure marking of the providers with accurate schedule identifiers to support claims adjudication.
• Provides effective customer service via multiple channels such as phone (to include inbound and outbound calls), written/email correspondence, etc. Performs service recovery techniques to resolve requests. Provides compliant and easily understood resolution options with the desired outcome of creating a positive customer experience. Utilizes resources to support service delivery resulting in retaining and/or growing the business.
• Meets and/or exceeds department standards related to attendance, productivity and quality
• Creates written letters to provide concise explanations to customers regarding claim determinations.
• Actively participates in self-development opportunities with a willingness to learn new skills and/or product lines.
• Actively participates in daily management through huddle involvement and the identification and supports implementation of process improvements. Provides insights and recommendations for enhancements to processes, training and the quality of service delivery to our customers.
• Has a primary focus on customer satisfaction, provides an effective level of customer service.
• Stays abreast of and adheres to Company processes and procedures, industry changes, federal and state legislation and regulations.
• May assist with the development, delivery and oversight of training and quality auditing program material.
• Develops and maintains effective working relationships with internal and external customers.
• Meeting and exceeding internal or external customer expectations while cultivating relationships that secure commitment and trust.
• Conveying information and ideas clearly and concisely to individuals or groups in an engaging manner that helps them understand and retain the message; listening actively to others.
• Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence rather than having standards imposed.
• Identifying and understanding problems and opportunities by gathering, analyzing, and interpreting quantitative and qualitative information; choosing the best course of action by establishing clear decision criteria, generating and evaluating alternatives, and making timely decisions; taking action that is consistent with available facts and constraints and optimizes probable consequences.
• Taking prompt action to accomplish work goals; taking action to achieve results beyond what is required; being proactive.
• Maintaining effectiveness when experiencing major changes in work responsibilities or environment (e.g., people, processes, structure, or culture); adjusting effectively to change by exploring the benefits, trying new approaches, and collaborating with others to make the change successful.
• Gaining others' confidence by acting with integrity and following through on commitments while disclosing own positions; treating others and their ideas with respect and supporting them in the face of challenges.
• Working cooperatively with others to help a team or work group achieve its goals.
• Assimilating and applying new job-related information in a timely manner.

ABOUT YOU:

• You help promote a culture of diversity and inclusion within the department and the larger organization. You value different ideas and opinions. You listen courageously and remain curious in all that you do.
• You are able to work remotely and have access to high-speed internet.
• Must be located in United States or Puerto Rico.
• Shows a sense of urgency and is accountable for work results.
• Ability to adapt to a diverse and changing work environment. Willingness to learn new skills with the ability to multi-task.
• Ability to work independently, and/or as part of a team, in a collaborative environment and is approachable.
• Effective time management and organizational skills with an attention to detail and analytical and decision-making abilities.
• Ability to meet deadlines in a fast paced work environment.
• Effective oral, written and interpersonal communication skills, sound judgment and the ability to think within a structured and compliant work environment while focusing on the customer.
• Working understanding of computer systems such as email, data entry, and Microsoft products, with proficient keyboarding skills.
• Ability to work flexible shifts and maintain regular and predictable attendance with adherence to department and company attendance expectations. May be required to work overtime based on business needs.
• Ability to assess and understand the needs of the customer and demonstrates flexibility in customizing approach and response to resolve requests in a respectful and timely manner.

We recognize that people come with diverse experience and talent beyond just the requirements of the job. Diversity of experience and skills combined with passion is a key to innovation and excellence. If your experience is relevant to what you see listed, please consider applying – we’d love to hear from you!

VALUABLE EXPERIENCE:

• High school diploma or work equivalent.
• Insurance product knowledge.
• Experience with the application of policies, practices and procedures in a business environment.
• Knowledge of medical terminology.

WHAT WE CAN OFFER YOU:

• A diverse workplace where associates feel a sense of belonging. To learn more about our commitment of Diversity, Equity and Inclusion, please visit our website
• An organization that feels like a small, close-knit community and has the strength of a Fortune 500 company.
• Tuition reimbursement, training and career development.
• Comprehensive benefits plan that includes medical, dental, vision, disability and life insurance.
• Flexible spending accounts for healthcare and childcare needs.
• 401(k) plan with a 2% company contribution and 6% company match.
• Competitive pay with an opportunity for incentives for all associates.
• Flexible work schedules with a healthy amount of paid time off.
• For more information regarding available benefits, please visit our Career Site.
• Regular associates working 40 hours a week can earn up to 15 days of vacation each year
• Regular associates receive 9 paid holidays in 2023
• Regular associates are provided sick leave through the use of personal time. Associates working 40 hours a week can receive up to 56 hours of personal time in 2023, prorated based on start date.
• Hourly Rate: $19.00/hr.
• Pay commensurate with experience.
• Recognized as a certified Great Place to Work®.

MUTUAL OF OMAHA:

Mutual of Omaha serves more than 4.8 million individual product customers and 39,000 employer groups. Our legacy of stability creates an environment where every associate is encouraged to experiment, innovate and grow in their own unique career path.

From day one, you’ll have the tools to be your best self at work. Here you’ll do meaningful work and your talents will have a positive impact on peoples’ lives as we help our customers protect what they care about and achieve their financial goals.

Each associate is a unique contributor to creating a diverse, dynamic, thriving and inclusive workplace. We want you to become engaged … feel a sense of belonging … and contribute to the company’s exceptional future.

We are committed to optimizing flexible work. We support a full range of work approaches: fully remote, hybrid and in-person. Many of our roles are remote. Employees in remote roles may occasionally travel to a Mutual of Omaha office or elsewhere for required meetings or team-building events. Remote employees who are assigned a Mutual of Omaha office location can work on-site on a voluntary basis, subject to local and company COVID-19 guidelines.

Join forces with a company that can AMPLIFY YOUR STRENGTHS AND EMPOWER YOUR CAREER.

For inquiries about the position or application process, contact our HR Helpline at 1-800-365-1405.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at 1-800-780-0304. We are available Monday through Friday 7 am to 4:30 pm CST we will reply within 24 hours.

Mutual of Omaha and its affiliates are an Equal Opportunity /Affirmative Action Employer. Qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

To All Recruitment Agencies: We do not accept unsolicited agency resumes and we are not responsible for any fees related to unsolicited resumes.

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Help: 800-365-1405

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