Claims Specialist
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Job Description
Claims Specialist processing Wellness and Hospital Indemnity insurance claims for Aflac. Providing customer service and documentation for policyholders while utilizing database systems.
Responsibilities:
- reviews and processes Wellness and Hospital Indemnity insurance claims based on information submitted by policy holders
- determines the nature and validity of claims by reviewing policy status, patient eligibility, and supporting medical and other documentation
- keys claims data while interpreting coding and medical terminology in relation to diagnoses and procedures
- uses multiple core administration databases, systems and subsystems to process and transmit claims for payment or further investigation
- provides prompt customer service to policy holders, providers and other internal company entities regarding claims
- documents phone calls in the system and follows-up on issues if needed
- contacts insured or other appropriate persons to verify the accuracy and completeness of information on claims forms and related documents
- responds to inquiries from policy holders, providers, agents regarding claim status and policy provisions
- provides back-up coverage for other teams as required
- maintains databases and prepares and extracts information using software systems
- performs various clerical duties as assigned, such as filing, photocopying, typing, maintaining databases and preparing and extracting information using software systems
Requirements:
- High School Diploma or Equivalent
- 1 year of work experience
- Experience and proficiency using Microsoft Office Suite software
- Fluency in Spanish with the ability to translate documents
Benefits:
- medical, dental, and vision coverage
- prescription drug coverage
- health care flexible spending
- dependent care flexible spending
- Aflac supplemental policies (Accident, Cancer, Critical Illness and Hospital Indemnity offered at no costs to employee)
- 401(k) plans
- annual bonuses
- opportunity to purchase company stock
- 11 paid holidays
- up to 20 days PTO to be used for any reason
- state-mandated sick leave (Washington employees accrue 1-hour sick leave for every 40 hours worked)
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