Claims Examiner

Duties and Responsibilities

• Receives and examines claims applications: Death, Disability, Killed-In-Action, Wounded-In-Action, Accident Hospitalization Benefits and other benefits of deceased members
• Determines coverage and corresponding benefit of claims and computes individual shares of beneficiaries
• Initiates suggestion and recommendation on claims with any legal issues to be resolved
• Transmits disability and WIA claims to medical consultant for evaluation
• Prepares claims disbursement vouchers and communication letters to claimants indicating claims settlement, computation benefit and completion of documents
• Encodes claims transactions in database and scans documents for reference
• Aids in communicating with beneficiaries regarding denied claims and claims with legal issues
• Prepares report on claims with CLI and E56 insurance coverage
• Handles claim register and prepares monthly claims register report
• Answers queries regarding claims from walk-in members
• Performs other related functions as directed by superior

Key Organizational Relationships

• Reports directly to the Supervisor, Claims

Qualifications

• Bachelor's degree in any business course
• With a minimum of 1-year related experience and relevant technical trainings, preferably on signature verification and forgery detection etc.
• Proficient in MS Office applications
• Strong analytical, composition, and prioritizing skills
• Detail-oriented and with good organization and coordination skills
• Ability to maintain confidentiality
• Good written and oral communication skills