Medical Claims Examiner

As one of the world's top International Medical Insurance companies, IMG helps individuals and companies of all sizes. Every second of every day, vacationers, those working or living abroad for short or extended periods, people traveling frequently between countries, and those who maintain multiple countries of residence use our products to give themselves global peace of mind. We are looking to grow our teams with people who share our energy and enthusiasm for creating the best experience for travelers.

Job Summary

Claims Examiners provide a service to our policyholders by reviewing claims to determine the validity of the insurance claim filed and identify the need for further investigations. Examiners resolve medical/dental/life/trip cancellation claims; documenting actions; maintaining their imaging queues; maintaining quality audit standards and ensuring their outcomes are following the Certificate of Insurance, Policy and Plan Documents as well as legal and regulatory agencies.

Duties And Responsibilities

• Determines covered insurance losses by studying provisions of policy or certificate.
• Establishes proof of loss by studying proof of claim; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims.
• Documents medical claims actions by completing forms, reports, logs, and records.
• Resolves claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter.
• Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.
• Maintains quality customer services by following core values.

Qualifications

• At least 1 year of prior medical claims processing experience OR willing to consider at least 2 years of experience with coding, billing, reviewing medical records, claims research, benefits review, medical office, or any other claims related role (i.e. complex claims, LCM claims, BI claims, P&C claims, etc.)
• Knowledge of basic medical terminology
• Ability to read and interpret insurance policy/certificate wording
• Ability to research and logically consider details from multiple sources to analyze and make a determination of benefits within a productivity-based environment
• Computer skills and proficiency in operating common office equipment
• Documentation, Data Entry Skills
• High attention to detail with ability to analyze information and Problem-solving skills
• Proficiency with basic math

Preferred Skills

• Knowledge of ICD-10
• Knowledge of FDA Health and HIPAA Regulations

Perks

• Quarterly performance bonus (*must meet department standards and qualifications)
• Flexible work schedule
• Comprehensive benefits package including Medical/RX/Dental/Vision insurance
• 401k Plan with company match
• Paid Time Off
• Free employee parking
• Tuition reimbursement plan

IMG is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, ethnicity, national origin, religion, gender, gender identity or expression, sexual orientation, genetic information, disability, age, veteran status, and other protected statuses as required by applicable law.