About this role
Open to local OKC candidates or fully remote
Evaluates, processes, manages and/or audits claims that require complex judgement and investigation such as , Cancer claims, Leave Absence Management Claims, Short Term Disability claims requiring claim management, Permanent and Total Disability claims or claims requiring Pre-Existing investigation, or life claims and claims on other life-related products and associated riders, and Stop Loss claims in accordance with Company policy terms, insurance laws, regulatory requirements, department standards and adjusting guidelines.
Provides appropriate verbal and/or written communication to internal and external Customers in a positive and knowledgeable manner to ensure a high standard of Customer service. Meets standards established in department performance metrics for appropriate handling of Customer phone calls.
Acts as a direct contact and communicates with internal and external Customers and medical providers in a positive, knowledgeable and professional manner, providing them with direction and assistance in all facets of insurance coverage and needs.
Requirements:
• Minimum 3 years claims processing experience
• FMLA/PFML experience required
• Prompt and reliable
• Advanced knowledge of medical terminology
• Proficient with PC Windows-based software, including Microsoft Office
• Easily adapts to new software/technology applications and is able to excel in a paperless environment
• Advanced contract knowledge
• Advanced familiarity with CPT and ICD-10 coding
• Possesses a high degree of decision-making ability
• Strong research and analytical skills
• Flexible work schedule, including willingness to work overtime as needed
• Strong communication skills, both verbal and written
• Ability to handle fast-paced environment
• Professional attitude
• Dedicated to providing world-class customer service
• Ability to work in a team environment
*Compensation range: $24.17/hour to $35.87/hour, plus may be eligible for an annual discretionary company bonus. Actual compensation within that range will be dependent upon the individual's skills, experience/qualifications and geographic zone. For more information on our organization and company benefits please visit our career site at http://americanfidelity.com/careers/.
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