Role Description
This position is responsible for examining routine and non-routine claims for one or more products and multiple series of contracts by evaluating the extent of liability within established guidelines. This position is accountable for analyzing claims to determine benefit/contract eligibility and processing claim transactions within specified dollar limits in compliance with state and federal regulatory standards, and NAIC (National Association of Insurance Commissioners) guidelines. Additionally, this position is a member of a team, actively partners with peers on meeting established service and quality standards, provides coaching and training to other Examiners and identifies opportunities for process improvements.
• Determine extent of liability on routine and non-routine claims and make final claim decisions within specified dollar limits.
• Contribute to accurate fraud detection and reporting by referring suspected fraud to appropriate staff for review according to established procedures.
• Analyze claim transactions and process payments utilizing various work flow, administrative, and LOB (Line of Business) systems, accurately and cost effectively according to contract provisions and in compliance with internal service and state and federal regulatory standards.
• Ensure high level of customer satisfaction by partnering with members, financial associates, doctors, providers, attorneys, police, vendors and other internal and external customers regarding claims, settlements and interpretation of policy provisions.
• Handle sensitive written and verbal communications.
• Actively participate in the development and implementation of business processes, standard operating procedures, documentation and other support materials required for unit operation.
• Provide consultation to Associate Claims Examiners in helping to answer questions and make decisions on claims with a moderate level of complexity.
Qualifications
• High school required. College degree preferred.
• Minimum of 2 years relevant experience.
• Professional credentials preferred (e.g. LOMA, ICA).
• Intermediate knowledge of claim administration and operations as well as pertinent laws and regulations.
• Must possess strong interpersonal skills, as well as excellent verbal and written communication skills.
Requirements
• As part of Thrivent Financial's hiring process, a verification of a candidate's background will be made to complete the hiring process.
• May represent the company at depositions and court appearances.
Benefits
• Various bonuses (including, for example, annual or long-term incentives).
• Medical, dental, and vision insurance.
• Health savings account.
• Flexible spending account.
• 401k.
• Pension.
• Life and accidental death and dismemberment insurance.
• Disability insurance.
• Supplemental protection insurance.
• 20 days of Paid Time Off each year.
• Sick and Safe Time.
• 10 paid company holidays.
• Volunteer Time Off.
• Paid parental leave.
• EAP.
• Well-being benefits, and other employee benefits.