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SWBC · 10 hours ago

Claims Examiner II

San Antonio, TX

Full-time

Onsite

Entry Level

1+ years exp

SWBC is seeking a talented individual to review and evaluate incoming claims for payment or denial and acts as a liaison for the carrier and the financial institution. The role involves adjudicating claims, preparing necessary documentation, and assisting claimants with inquiries while ensuring compliance with company standards.

BankingFinanceFinancial ServicesInsurance

Responsibilities

Adjudicates routine to moderately complicated Payment Protection claims and determines if benefits are payable or not; ensures claims are adjudicated within the customer service level standards established by the company with adherence to Prompt Payment of Claims Regulation respective to each state

Prepares letters and requests any information needed to make a determination on claims from insurance carrier, family, claimant, physicians, employers, and others. Submits all claims determined contestable to carriers for review and final determination

Calculates the benefit amount and ensures claims are not being overpaid or underpaid according to the provisions within the specific insurance certificate/policy form that describes the terms and conditions of the applicable coverage

Assists claimants or financial institutions via phone to answer questions, and documents such within the claim file

Maintains carrier guidance and administrative files, required logs to comply with carrier requirements, reviews and evaluates instructions provided by carriers and assists management with proper implementation

Completes request for refund form and submits to Premium Processing; verifies monthly outstanding loan balances for active and inactive financial institutions; and ensures that open accounts loan balances are verified every 6 months and closed accounts are verified each month; provides back-up assistance to the claims processor position for establishment and set-up of new claims

Qualification

Claims processing experienceMedical terminology knowledgeMicrosoft Word proficiencyMicrosoft Excel proficiencyBusiness letter draftingOrganizational skillsInterpersonal skillsDetail oriented