Claims Examiner I, Job# 0615-20

Claims Examiner I, Job# 0615-20

Prosperity Service Group, LLC is seeking to hire a Claims Examiner I for our Roanoke, VA office. This position examines, investigates, summarizes, and approves or recommends action on individual life, disability and annuity claims to include policy maintenance, tax reporting and benefit distribution. 

Essential Duties and Responsibilities include the following. Other duties may be assigned.

  • Assures timely, accurate administration of individual life and disability claims.
  • Through the review of medical records, lab reports, other medical reports, police and accident reports and other investigative reports, examines, summarizes and approves contestable and incontestable life and annuity claims within authority guidelines or recommends actions to management.
  • Through the review of attending physician statements, medical records and other investigative reports, examines, summarizes and approves or recommends action on disability claims.
  • Corresponds with agents, policyholders, hospitals, doctors, attorneys, and claimants.
  • Observe appropriate confidentiality in communicating all sensitive claim information including MIB information.
  • Maintain a working knowledge of claim examination practices by participating in claim educational programs.
  • Maintain current knowledge of state regulations regarding claim practices.
  • Participate in planning for departmental changes which impact claims processing.
  • Interface with service providers to assure claim processing remains cost effective.

Job Qualifications

Bachelor's degree (B.A.) from four-year college or university; or equivalent combination of education and experience.  Minimum of two years experience in a professional office environment.  Prior insurance experience preferred but not required.

Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Skills and Abilities

  • Work requires the ability to read and interpret documents such as procedure manuals and operating instructions.  Ability to write routine reports and correspondence.  Ability to speak effectively before groups of customers or employees.                                                                                      
  • Ability to calculate figures and amounts such as discounts, interest, commissions, and percentages.  Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
  • Ability to solve practical problems and deal with a variety of variables in situations where any limited standardization exists.  Ability to interpret detailed instructions furnished in written, oral, diagram, or schedule form.  Ability to develop alternative solutions and apply specific resources or techniques to solve problems.  Ability to draw inferences from partial information.
  • Intermediate experience or knowledge in the use of Microsoft Office (Word, Excel, PowerPoint), or other industry specific software.  Must be a good team worker with the ability to handle multiple responsibilities.  This job requires the proficiency to read, analyze and summarize medical records, lab tests and other medical studies.  The incumbent is required to formulate decisions and recommendations based on these factors.  Knowledge and understanding of medical terminology preferred but is not required.  Must have good organizational skills.  Must be able to pay close attention to details and have good reasoning and decision making skills.

Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to walk. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

To apply, please send resume to [email protected] and reference Job #0615-20.