Claims Specialist II, Life & Health

The nation's leading administrator of insurance services is looking for YOU. This is your opportunity to join a company with a culture that promotes respect for people, integrity, learning and initiative. WE ARE THE KIND OF EMPLOYER YOU DESERVE. illumifin is a leading provider of business process outsourcing for the insurance industry, managing policies for the nation's largest insurers. We also provide clients with unique risk management insight built upon our proprietary databases. Responsible for training, Quality assurance, and procedural development for Life and Health Claims. Communicates with internal and external customers regarding actions taken or to be taken. Performs analysis and oversees projects to enhance department development, client needs and service objectives. Provide direction and assistance to Claims team . Handles complex claims, including adjustments and complaints and is a resource to claims team. Effectively communicate, in writing and verbally, all aspects of plan coverage, provider requirements and steps in the claim process. Responsible for adjudicating more complex claim requests and special handling claims, including reversals adjustments and complaints. Must maintain procedural accuracy of 95% and dollar accuracy of 98%. Provide training to team (both onshore and offshore) , develop training materials, answer questions, check and monitor quality of work. Project management. Identify and develop on-going needs of claim department, including evaluating existing system needs and manage required system enhancement and modifications. Provide input toward solution to department issues. Develop new and on-going procedures and policies for new and existing clients or vendors. This includes revision existing policies and procedures. Improve process flows and efficiencies. Work completed and process flows must be prompt, efficient and accurate. Overseas and assists with day to day activities and inventory while keeping leadership informed. Provides prompt, courteous and excellent customer service to internal and external customers at all times. This includes an obligation to actively cooperate and interact with other departments to advance the overall interest of Illumifin Demonstrates understanding of company-wide, department-specific policies and protocols. Maintains the confidential and proprietary nature of company policies. Other duties and projects as assigned.