New Era Life Insurance Companies ยท 1 day ago
U65 Claims Examiner
Houston, TX
Full-time
Hybrid
Mid Level
3+ years expNew Era Life Insurance Companies is seeking a U65 Claims Examiner who will be responsible for reviewing, investigating, and processing Individual health and accident claims. The role involves collaborating with department leadership, ensuring compliance with regulations, and maintaining accurate claim processing.
Insurance
Responsibilities
Review, evaluate, and process Individual health and accident claims in accordance with policy language and established procedures
Manage an assigned claim inventory as directed
Conduct preexisting condition and contestability investigations as required
Maintain and process claims precoded by IT and learn simple processing for Individual Indemnity Plans
Review and interpret medical records to determine eligibility and benefit application
Apply working knowledge of insurance and medical terminology
Develop foundational understanding of ICD10, CPT, and HCPCS coding (advanced knowledge considered a plus)
Evaluate highdollar and certain complex claims with attention to accuracy and compliance
Ensure claims are processed in accordance with HIPAA, the Affordable Care Act, and other applicable state and federal regulations
Maintain accurate documentation of claim decisions and investigative steps
Support audit readiness and ensure adherence to internal quality standards
Coordinate with Claims leadership and other Claims units to ensure consistent handling of claim issues
Collaborate with other internal departments to support efficient information flow and strong interdepartmental communication
Respond to internal inquiries and support resolution of issues related to claim processing
Participate in departmental initiatives, training, and workflow improvements
Maintain assigned work schedules, production expectations, and accuracy standards
Perform other duties as assigned by management
Qualification
Required
3-5 years of experience managing complex or high-dollar health claims, preferably within Individual health insurance
Ability to interpret medical records and apply policy language accurately
Strong written and verbal communication skills
High attention to detail, strong organizational skills, and the ability to manage multiple priorities
Knowledge of insurance and medical terminology
Self-motivated, resilient under pressure, and able to learn quickly
Legally authorized to work in the United States
Ability to successfully pass a background check
High School diploma or equivalent (GED) required
Preferred
Prior experience with Individual Indemnity Plans
Basic knowledge of ICD10, CPT, and HCPCS coding systems
Proficiency in claims systems and Microsoft Office applications (Word, Excel, Outlook)
Company
New Era Life Insurance Companies
The company was founded in 1989 by Dr. Bill Chen, CEO and Founder of New Era.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase