Supervises and coordinates activities of workers engaged in examining insurance claims for payment in claims division of insurance company. Ensures all claims eligible or ineligible for payment conform to quality, production standards and specifications. A bachelor's degree with four years... [+] More
Supervises and coordinates activities of workers engaged in examining insurance claims for payment in claims division of insurance company. Ensures all claims eligible or ineligible for payment conform to quality, production standards and specifications. A bachelor's degree with four years of claims examining/auditing experience may be required to fulfill the requirements of this position.
Ensures evaluation of all claims through determination of types and amounts of benefit payable. Ensures/oversees documenting of provider claims/billing forms to support payment/decisions. Ensures claims processing is consistent with applicable policies, procedures, and department guidelines. Supervises maintenance of claims records. Reviews appeals and complaints that Examiners are unable to resolve. Analyzes and approves insurance claims. Conducts personal interviews with claimants to explain procedure for filing claims. Submits statement of claim liabilities to actuarial department for review. Informs departmental supervisors on claims status. Interprets company policy to employees and enforces company policy and practices. Reviews and analyzes processes, procedures, and workflows to identify opportunities for process improvement and efficiency. Prepares regular periodic reports, and reviews/monitors system reports to ensure adherence to corporate and regulatory standards within established guidelines. May participate in the specialized training and handling of complex claim situations and projects requiring advanced claim knowledge and experience, as delegated by Claims Manager and/or Director. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action. (Source: eDOT Job Description) [-] Less
Cost of Living Data
A renter's cost of living for someone making $67,848 in Reading, Pennsylvania is 97.1% of the US National Average. For more information, or to compare cost of living data between two cities, click here.
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