CLAIM ANALYST
Pekin Insurance - Pekin, IL

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After nearly a century of protecting people and building futures, Pekin Insurance is dedicated to go beyond. Beyond the expected®. Our rule is golden: Give our customers what we would want ourselves. Give them service that goes the extra mile and products that meet both today’s need as well as tomorrow’s. Give our customers the financial stability that provides what we all want in today’s world: peace of mind.

Pekin Insurance is one of the top Property & Casualty insurance companies in the United States and ranks 111th out of 3,000 companies which puts us in the top 4% of Property & Casualty insurance companies in the nation. Pekin Insurance also ranks 140th out of 900 Life insurance companies in the nation—making Pekin Life in the top 16%. In the Midwest, Pekin Insurance boasts more than 850,000 policyholders and offers a broad portfolio of products sold by an independent agency force.

Our over 700 Home Office and Service Office employees lead by example in a team-effort environment where each member takes part in the decision-making process, while remaining committed to going Beyond the expected® in all their endeavors.

For more information, visit www.pekininsurance.com

Claim Analyst

Position Objective:
Complete a variety of professional assignments related to reviewing, evaluating, determining and processing health plan benefits for medical and/or dental, vision, and disability claims.

Job Responsibilities:
• Complete all task required to review and appropriately apply health plan benefit provisions and exclusions
• Implement and apply medical cost containment procedures and guidelines for healthcare claims
• Review all healthcare claims for reasonable and appropriate charges
• Evaluate treatment plans and other healthcare services for appropriate medical management to include referrals to outside independent review
• Provide second level reviews of claims for which the provider and/or policyholder appeals the reduction or denial of plan benefits
• Provide high levels of customer service to policyholders, providers, agents and group administrators
• Maintain records, prepare reports and create professional business correspondence
• Participate in team based projects to successfully accomplish department and/or corporate defined goals
Education/Skills and Experience:
• Bachelors Degree is required; Business Administration or Insurance preferred
• Prior TPA experience is preferred
• 2-3 years of professional experience in contracting, billing, authorizing or monitoring medical based services or accounts
• Experience with ICD 9/10, CPT and HCPCS coding is preferred
• Strong computer skills are required (Microsoft Word, Excel and Outlook)
• Knowledge of healthcare reform and its impact in reference to the health insurance industry
• Knowledge of medical, pharmaceutical and other health service practices and terminology
• Knowledge of health care billing standards, practices and procedures
• Ability to understand and apply complex policies and procedures
• Ability to maintain high levels of confidentiality to include a sound understanding of HIPAA compliance
• Exhibit strong written, verbal and interpersonal communication skills
• Capability to manage multiple tasks and work within established turnaround times
• Ability to balance high levels of production with high levels of quality output
Working Conditions:
• Ability to work independently in a high pressured environment
• Overtime required in accordance with claim volume increases
Physical Requirements:
• Visual ability sufficient to read written information and computer displays for long periods of time
• Repetitive wrist motion from use of mouse and keyboard
• Speaking and hearing ability sufficient to carry on a conversation with other individuals in person and over the telephone
• Incumbent is required to sit for long periods of time
Benefits Include:
• Health, Dental & Vision Plan
• 401(k) with Company Match
• Flexible Spending Account
• Tuition Reimbursement
• Vacation Time and Paid Holiday
• Life Insurance
• Long-Term Disability Insurance
• Employee Assistance Program
• Employee Discounts on Auto and Homeowners policies
• On-Site Café

Pekin Insurance - 13 months ago - save job - block
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About this company
5 reviews
WE SELL PROTECTION AND HELP BUILD FUTURES. AT PEKIN INSURANCE, WE PROVIDE PEACE OF MIND AND LONG-TERM SECURITY FOR OUR POLICYHOLDERS,...