Aflac
Claims Specialist
2w ago
USARemotecustomer servicemicrosoft officeclaims processingmedical terminologytime managementdata entry
Aflac, a Fortune 500 leader in voluntary insurance products, is hiring a remote Claims Specialist based in the US to process wellness, accident, and vision insurance claims and provide customer service.
About the company
- Aflac, a Fortune 500 company, is an industry leader in voluntary insurance products that pay cash directly to policyholders and one of America's best-known brands.
- Aflac has been recognized as Fortune’s 50 Best Workplaces for Diversity and as one of World’s Most Ethical Companies by Ethisphere.com.
- Our business is about being there for people in need.
Responsibilities
- Under immediate supervision and in accordance with established policies and procedures, reviews and processes Wellness, Accident and Vision insurance claims based on information submitted by policy holders; determines the nature and validity of claims by reviewing policy status, patient eligibility, and supporting medical and other documentation
- Keys claims data while interpreting coding and medical terminology in relation to diagnoses and procedures; uses multiple core administration databases, systems and subsystems to process and transmit claims for payment or further investigation
- Provides prompt customer service to policy holders, providers and other internal company entities regarding claims; documents phone calls in the system and follows-up on issues if needed; contacts insured or other appropriate persons to verify the accuracy and completeness of information on claims forms and related documents, responds to inquiries from policy holders, providers, agents regarding claim status and policy provisions
- Provides back-up coverage for other teams as required, maintains databases and prepares and extracts information using software systems; performs various clerical duties as assigned, such as filing, photocopying, typing, maintaining databases and preparing and extracting information using software systems
- Performs other related duties as required
Requirements
- Knowledge of principles and processes for providing customer and personal services; this includes needs assessment, meeting quality standards for services, and evaluation of customer satisfaction
- Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, and other office procedures and terminology
- Skill in giving full attention to what other people are saying, taking time to understand the points being made; asking questions as appropriate
- Skill in understanding the implications of new information for both current and future problem solving and decision-making
- Skill in using mathematics to solve problems
- Skill in selecting and using training/instructional methods and procedures when learning new policies, procedures, concepts, or products
- Skill in managing one’s own time and actively looking for ways to help people
- Positions requiring the use of bilingual skills (if applicable to this position): Fluency in Spanish with the ability to translate documents
- High School Diploma or Equivalent
- 1 year of work experience
- Experience and proficiency using Microsoft Office Suite software
Nice to have
- Experience with medical terminology
- Or an equivalent combination of education and experience
Conditions
- This role is a remote role expected to work from home within the continental US, with possible occasional office visits communicated in advance
- Salary range from $37,000 to $43,680 annually, with other benefits including medical, dental, vision, prescription coverage, flexible spending accounts, Aflac supplemental policies (at no cost to employee), 401(k), annual bonuses, company stock purchase opportunity
- 11 paid holidays, up to 20 days PTO, and eligible state-mandated sick leave and other leaves of absence