Claims Approver

$50,000 - $65,000/Yr

Keenan & Associates - Ontario, CA

Full-time - Entry Level

Remote - Ontario, CA

Insurance Carriers and Related Activities

About the position

The Claims Approver position at Keenan involves accurately adjudicating a high volume of benefit claims in accordance with Plan provisions and ERISA guidelines. The role requires prompt and professional responses to issues related to claims and benefits, ensuring compliance and efficiency in the claims process.

Responsibilities

• Process claims and adjust claims previously processed incorrectly.
• Determine appropriate action for reversal and/or reprocessing of claims.
• Request refunds if necessary and compose/distribute necessary correspondence.
• Follow up on pending claims and review claim reports to determine necessary actions.
• Request additional information as needed and bring closure to claims when requested data has not yet been received.
• Refer complex claims and related service issues to Senior Claim Approvers.
• Identify and process claims through Keenan vendors.
• Observe and report trends in claims processing.
• Perform other duties as assigned.

Requirements

• Minimum of 3 years previous group claims experience required.
• At least 1 year of experience with self-funded/PPO claims recommended.
• Knowledge of medical terminology and familiarity with standard reference materials required.
• Completion of HIAA Group Courses preferred.
• Excellent problem-solving skills and written/verbal communication skills required.
• Proficiency in Outlook and Microsoft Windows is a must.

Nice-to-haves

• Experience with self-funded/PPO claims is preferred.
• Completion of HIAA Group Courses is preferred.

Benefits

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Vision insurance