Claims Examiner - Benefits Solutions

Claims Examiner - Benefits Solutions

Job ID #: 92376
Location: TX-Amarillo
Functional Area: Claims
Company: 10001 - American International Group, Inc.
Employment Type: Full Time - Permanent
Education Required: Some College
Experience Required: 1 to 2 years
Relocation Provided: No
Travel Percentage: 0

Position Description:

Chartis and SunAmerica Financial Group formed a significant new player in the benefits market by combining American General Life Companies' Benefit Solutions division with the Medical Excess and @Work groups from Chartis Corporate Benefits division. The combined entity targets the employee and affinity group markets, and will serve as a one-stop solution for today's changing benefits marketplace for groups of all sizes. The product suite includes life/AD&D, BTA/accident, universal and term life, dental, vision, limited healthcare, medical reimbursement, stop-loss, organ transplant, group hospital, group and personal disability, critical illness, accident and cancer insurance. This broad and diverse portfolio provides limitless opportunities to create flexible benefit offerings suitable for all sizes and budgets, and the combined underwriting, distribution and sales strengths of American General and Chartis provides further strength and differentiation in the marketplace.

The Claims Examiner performs all functions necessary to properly adjudicate Group Health claims in an automated environment in accordance with established company procedures and State Insurance Department regulations. Standards for production and accuracy must be met and surpassed consistently. The Claims Examiner provides service to customers/clients via ability to communicate claim payment or denial details in a concise, professional manner.

Candidates will be reporting to a hiring manager in Neptune but will be based in Amarillo Texas. You will be communicating with internal partners, clients and third party vendor.

Performance Objectives

Process claims of varying difficulty at a level consistent with the production and quality standards (99% financial accuracy) set by the department.
Investigates, either by direct correspondence or investigative sources, eligibility or other policy qualifications as necessary to determine claim liability.
Approves claims within scope of authority
Answers telephone inquiries relative to new, pending or settled claims; communicates in a tactful, courteous and knowledgeable manner.
Prioritize work to meet established production standards.
Identify claims requiring additional review and direction by senior examiner, supervisor or technician.
Identify opportunities for cost savings such as case management, coordination of benefits and possible contracted or negotiated discounts.
Participate in and contribute to unit meetings.

Position Requirements
The Ideal Candidate Should Have

College degree or high school diploma combined with 1 to 2 years medical claims experience in an automated environment.
Some formal insurance education desired. Ability to self-study and pass licensing exams as required by the various states/company within specified time frames.
Ability to read and interpret documents such as insurance policies, treatment plans, supervisor instructions and procedural manuals.
Good technical and investigative skills; understanding of insurance and medical terminology.
Proficient knowledge of computers, including use of software available.
Working knowledge of Microsoft Excel and Word.
Proficient written communication skills.
Must be able to travel for training to Neptune, NJ for 4-8 weeks returning to Amarillo every other weekend.

About Us:

American International Group, Inc. (AIG) is a leading international insurance organization serving customers in more than 130 countries and jurisdictions. AIG companies serve commercial, institutional, and individual customers through one of the most extensive worldwide property casualty networks of any insurer. In addition, AIG companies are leading providers of life insurance and retirement services in the United States.

AIG Property Casualty is a global market leader, one of the few truly global property casualty franchises.

AIG Life and Retirement is one of the largest life insurance organizations in the U.S., and provides protection, investment and income solutions needed for financial and retirement security.

United Guaranty Corporation is the marketplace leader in mortgage insurance in the U.S.