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Company: Banner Corporate Center Mesa
Location: Mesa, AZ
Job Title: Claims Processing Director
Banner Health is currently seeking a Claims Processing Director. The Reimbursement Services department is responsible for claims adjudication, recovery and management for Banner Choice Plus/Select, Blue Advantage, HealthNet Medicare Advantage and UHC Medicare Advantage. They are also responsible for management of the eligibility and funding for Banner Choice Plus and Select.
You will provide leadership by directing the planning and implementation of the reimbursement systems, annual enrollment and eligibility, network data management, Active Health maintenance and benefits administration functions for the company’s self-funded employee benefit plans, commercial risk, capitation, Medicare Advantage Plans, special payment plans and Third Party Administrator (TPA) contracts. You will develop, implement, and manage business processes and procedures necessary to ensure high levels of performance, accuracy, and operational integrity.
To thrive in this position, you must possess:
- Knowledge typically gained from the completion of a Bachelor's degree in the business, finance or healthcare administration field or the equivalent training and experience
- Experience in reimbursement, claims and related systems, provider contract interpretation, system development, typically achieved with seven or more years’ experience, including supervisory experience
- Demonstrated proficiency in implementing complex provider compensation models. Analytical and critical thinking skills required to interpret diverse data requirements
- Ability to integrate information to establish business-based priorities, decisions and budgets and ability to develop strong relationships with suppliers and customers and to effectively communicate with employees, providers, the medical staff, and Healthcare, Hospital management staff
For immediate consideration, apply directly https://jobs-bannerhealth.icims.com/jobs/136527/claims-processing-director/job or visit www.BannerHealth.com/careers for more information.
About Banner Health (Corporate)
Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. With locations in Phoenix and Mesa, we offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care.
About Banner Health
Banner Heath is a comprehensive, award-winning, nonprofit health system with facilities in seven western states. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices, and much more, our skilled and compassionate professionals use the latest technology to change the way care is provided. The many locations, career opportunities and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.
EOE/AA. We support a tobacco-free and drug-free workplace.
Company: National Life Group
Location: Vermont or Texas campus
Job Title: Senior Life Claims Examiner
Senior Claim examiners are accountable for determining the extent of the Company’s liability in Claims under all forms, and all amounts of its in-force life insurance portfolio, in-force disability insurance and waiver of Premium/Monthly deduction portfolio. In addition, they authorize settlement thereof in compliance with contractual provisions, company practice and philosophy and the various governmental and judicial laws and regulations regardless of complexity or circumstances.
- Acquire a thorough understanding of the various life, annuity and disability insurance products and riders in-force on the Company’s books including any liberalization
- Pioneer in new products, in documenting, administering and processing for the first time
- Conduct or direct any necessary investigation to determine the extent of Company liability in claims which apparently present no substantial settlement questions
- Authorize and direct settlement of life insurance claims including matured endowments, annuities and claims under installment certificates in accordance with decision authority established
- Authorize and direct settlement of disability income payments including waiver or premium / waiver of monthly deduction / Waiver of Target premium / Waiver of specified premium; this also includes denials and the explanations and reasoning in the communication process
- Authorize and direct settlement of Accelerated Benefit claims that vary by type and company; this also includes denials and the communication with explanations and reasoning
- Contribute to the conduct or direction of investigations regarding claims which do present a substantial question of Company liability and/or settlement issues, recommend action concerning misrepresentation, suicide, accidental deaths, disappearance, fraud and other situations
- Responsible for the co-approval authorization and direction of settlement in claims exceeding the single decision authority levels of other claims examiners
- Develop understanding and application of medical terminology, insurance law, tax law and financial principles
- Communication daily in writing and verbally with policy owners, agents, attorneys, beneficiaries and physicians in the review, approval or denial of all claims
- Work closely with law, compliance, reinsurance companies, actuarial, underwriting and others to maintain the contractual provisions and company practices
- Training, communicating, reviewing, co-approvals and referral for claim examiners and trainees
- Bachelor’s Degree preferred; medical/clinical coursework a plus
- LOMA course work towards the FLMI designation would be very beneficial and considered a plus
- Completion of al ICA, and ALHC Program courses
- Attention to detail and the ability to work efficiently under pressure is essential
- Maintain confidentiality and strong professional client relationships
- Understand and follow oral and written instructions
- Work independently in the absence of supervision
- A strong work ethic and a demonstrated ability to work independently in a fast-paced environment with a high degree of accuracy
- Establish and maintain effective working relationships with those contacted in the course of work
- Proficient use of personal computer (PC) to include Microsoft Word, Excel and Outlook
- Must be able to successfully complete a background check
National Life Group® is a trade name of National Life Insurance Company, Montpelier, VT, and its affiliates.
Application Link: https://chj.tbe.taleo.net/chj01/ats/careers/requisition.jsp?org=NATILIFE&cws=37&rid=743
About the company:
National Life Group is a diversified family of financial service companies that offer a comprehensive portfolio of life insurance, annuity and investment products to help individuals, families and businesses pursue their financial goals.
National Life Group, a Fortune 1000 company, serves 786,000 customers. With 2013 revenue of $2 billion and net income of $142 million, members of National Life Group employ roughly 900 employees, with most located at its home office in Montpelier, Vermont. Group companies also maintain offices in Addison, New York, and San Francisco
The Group is made up of its flagship company, National Life Insurance Company, founded in Montpelier, Vermont in 1848; Life Insurance Company of the Southwest, founded in 1955, Addison, Texas, and Sentinel Investments and Equity Services, Inc., all based in Montpelier.
We offer all that you would expect from a major corporation: a choice of health care plans, pension plan, 401(k), life insurance, short and long term disability, and more. Our company highly values community and the environment. We offer a variety of benefits that are far from common. For instance, each employee receives up to 40 hours of paid volunteer time, and the company provides incentives for employees to use alternate forms of transportation, such as gas cards for car poolers and preferred parking for fuel efficient vehicles. Opportunity and development are more than just words to us. We offer tuition reimbursement, support for achievement of professional designations, and the newly established National Life University, offering a variety of courses for personal and professional growth.
Location: Boston, MA/ Work from Home
Job Title: IDI Field Claim Representative #83821
- Position requires home base in Massachusetts with travel within and outside of the state.
Responsibilities include ensuring claim accuracy by conducting highly detailed interviews with customers and their representatives, including attorneys, extensive report writing, providing detailed and comprehensive reports of visits through cost effective practices, resource utilization, and compliance with existing state laws, state insurance department regulations, and time service expectations. Position requires the use of independent analysis and judgment to determine the scope of customer facing interview to include, the need for collateral detail and the use of investigative modalities. Individual will embrace MetLife’s travel initiatives and manage expenses consistent with policy and procedure.
Position requires a customer centric approach to communication, effectively communicating/partnering with internal and external customers to ensure a thorough understanding of claim. Effective communication of policy provisions, claim status and company’s position a must.
Key Competencies, Qualifications and Skills, Preferred:
Please click here for additional details and to apply for this position.
Company: Gerber Life Insurance Company
Location: Fremont, MI
Job Title: Life Claims Examiner
- Gerber Life Insurance Company is hiring! We have been providing superior quality life insurance products since 1967. We offer an array of insurance products to meet the needs of individuals and families, including The Grow-Up® Plan, The Gerber Life College Plan, and adult coverage products, including Term Life, Whole Life, Guaranteed Life, and Accident Protection. As an affiliate of Gerber Products Company, “the baby food people,” the two companies share a common goal: to help parents raise happy, healthy children. Gerber Products Company and Gerber Life are companies of the Nestle organization.
Evaluate claim information and decide appropriate course of action to properly assess, clarify, and appraise the claim in compliance with policy provisions, claim procedures, legal requirements and professional ethics.
Includes but not limited to: Review, analyze, investigate, and authorize payment of life insurance claims within authority guidelines; Evaluate claim information and decide appropriate course of action to properly assess, clarify, and appraise the claim in compliance with policy provisions, claim procedures, legal requirements and professional ethics; Provide guidance regarding general claim policy, as well as specific claims problems involving the validity of claim, interpretation of policy contracts and terminology; Control work procedures and may coordinate claim work within the department; Facilitate resolution of complaints, concerns and disputes received from claimants, attorneys and State Insurance Departments; May coordinate claims quality control, audits, and training. Identify trends, efficiency and improvement opportunities; Assist in project and new product development as assigned by management; May communicate directly with policyholders, beneficiaries, hospitals, doctors, attorneys, state insurance departments, and other internal and external areas. Contacts involve planning and preparation of the communications, require skills, tact, persuasion and negotiation to reach resolution; May be required to complete additional training/educational courses toward the attainment of designations such as ALHC/FLHC, and ACS.
- Bachelor’s degree or equivalent work experience
- Preferred: LOMA Level 1 Certificate (courses: 280/281 and 290/291); UND 386; ACS Designation; ALHC Designation; and FLHC
Key Competencies, Qualifications and Skills, Preferred:
- Ability to deal effectively with external customers, some of whom will require high levels of patience, tact and diplomacy to diffuse emotionally charged issues and collect accurate information to resolve conflicts.
- Ability to read, listen and communicate effectively both verbally and in writing in order to prepare formal and informal correspondence; as well as provide clearly articulate reasons for initiatives, guidance for internal/external customers, instructions, etc.
- Good level of competence with organization, prioritization and multi-tasking environment
- Good judgment with proven ability to accurately investigating, analyzing, summarize detailed information in order to solve complex issues.
- Understanding of compliance with Life Insurance and advanced knowledge of Life/Health Claims
- Excellent judgment, problem solving, decision making and follow through skills
- Ability to coach and mentor both peers and associates
- Advanced level of PC skills
- High level of candor, trust and integrity
- Change agent and have a proven track record for delivering results
- Motivated with the flexibility necessary to operate is a fast growing and fast paced environment
Application Link: www.nestlejobs.com - Job Number: 15001806
All postings will remain for 60 days unless otherwise noted
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