Physicians Mutual Insurance Company

Physicians Mutual’ s Claims team is hiring! In this role, the Claim Examiner evaluates and responds to health claim service requests for Customers, providers and entitled parties.Duties Include:Following analytical and procedural duties with Customer Focus emphasis at all stages.With high attention to detail, evaluates claim information in conjunction with policy and benefit rider provisions, company claim philosophy, medical conditions, claim department guidelines and state insurance regulations.Evaluates all information received to make proper payment or reject decision.Effectively correspond with decisions to insured, providers and other interested parties through appropriate communication channels.

ABOUT THE JOB

Qualifications:High school diploma or equivalent is necessary to obtain the reading comprehension, math and communication skills needed to perform the required duties.Above average written and verbal communication skills are necessary to effectively correspond with Policyowners and other interested parties.Ability to operate a PC and all applicable programs and applications.Must possess problem solving, decision-making, and organizational skills.Ability to function effectively in a production environment with high quality work.Ability to learn quickly and adapt to new insurance coverages, procedures and guidelines.Basic math needed to calculate benefits and interest. Preferred Qualifications:Prefer a minimum of 1-2 years of previous health insurance or related experience.Good working knowledge of the function of other departments and their relationship to the claims process.

OTHER

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