Claims Analyst jobs in Peoria, IL
Claims Analyst analyzes and reviews insurance claims for accuracy, completeness, and eligibility. Reviews claims for eligibility to be reimbursed. Being a Claims Analyst maintains updated records and prepares required documentation. Assists in controlling the cost of processing claims. Additionally, Claims Analyst contacts policyholders about claims and may provide information regarding the amount of benefits. May require a bachelor's degree or its equivalent. Typically reports to a supervisor or manager. The Claims Analyst gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Claims Analyst typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Recently Added Claims Analyst jobs
Claims Representative
- Missouri Employers Mutual
-
Bloomington, IL
FULL_TIME
-
Are you driven to keep people safe? That’s what we do every day at Missouri Employers Mutual.
We’ve created a casual, values-driven work culture that’s making a positive impact on the way people live and work. This is a place where you can grow with confidence — because that’s what safety and success really mean to us.
SUMMARY:
Under the general direction of the Claims Manager or senior level Claims Reps: investigates, evaluates, negotiates, and settles assigned medium/high exposure, with some highly complex claims, following sound claims handling techniques and in accordance with company claims philosophy, statutory requirements and quality assurance standards. Must be able to work independently, with minimal supervision and within assigned authority.
Claims Investigations
- Investigates assigned claims for coverage, promptly notifying Corporate Claims of any issues, so that MEM’s position can be evaluated, and appropriate correspondence issued. Documents every claim with a coverage analysis notepad.
- Investigates assigned claims for compensability and any applicable drug/safety/alcohol penalties, in accordance with the appropriate state statutes. This includes taking verbal, written or recorded statements from key witnesses and securing any and all records to document and support the decision made.
- Recognizes and acts upon opportunities when a Face-to-Face visit would provide maximum value to investigate, establish rapport or minimize litigation potential. Engage Field Service Manager to assist when needed.
- Remains alert to opportunities when surveillance may be an effective method for either managing disability or supporting Special Investigation needs. Secures approval for this process, evaluates an appropriate vendor and manages the cost/benefit balance while using this tool.
- Identifies subrogation, investigates and documents third party liability in order to maximize potential recovery dollars.
- Oversees the medical aspects of the files to ensure quality care in a cost-effective manner. This includes working with network providers, referring to Utilization Management, engaging Nurse Case Management when appropriate and securing special opinions as needed (such as Specialists, Independent Medical Evaluations, Second Opinions, Functional Capacity Evaluations, Medical Director input, permanent restrictions, and lifetime medical needs). Reviews and processes medical bills in a timely manner.
- Ensures system data integrity by entering and maintaining accurate information in required fields.
- Documents files with all relevant facts and actions taken, action plan, necessary reports, investigative notes, and other data as may be required by the state Workers’ Compensation Law, Federal Longshore and Harbor Workers' Compensation Act, the State Insurance Department and MEM guidelines.
- Effectively manages disability via the Return-to-Work Program, which includes securing job descriptions and Policyholder education about the benefits of providing light duty. Ensures accuracy of disability payments by securing wage statements and correctly calculating rates, which may include securing and analyzing tax information. Ensures benefit payments are timely and in accordance with statutory requirements so that there is no exposure to penalties or interest.
- Establishes and maintains claim reserves, which in the aggregate are sufficient to discharge ultimate corporate liability. This requires timely responsiveness to changing claim circumstances, with avoidance of stair-stepping or significant adverse development. File documentation should be sufficient to explain the rationale for reserve changes. Secure approval for any reserves beyond stated authority. Completes Serious Claim Notices according to guidelines.
- Obtains medical disability ratings in accordance with statutory requirements. Evaluates a reasonable settlement range for claim resolution and negotiates settlements (either directly with the Injured Worker or, if represented, with their attorney) within approved authority levels.
- Recognizes appropriate opportunities for structured settlements and employs the necessary resources to develop and negotiate this type of settlement.
- Directs attorneys in preparing assigned claims for defense and manages legal throughout claim to final resolution/settlement. Collaborates with counsel to determine legal plan of action, which may include depositions, medical examinations and vocational evaluations. Ensures MEM litigation guidelines are followed throughout the process and in review/approval of legal bills submitted.
- Recognizes claims with Medicare exposure and works with defense counsel to protect Medicare’s interests. Obtain Medicare Set-Aside Trusts from approved vendors and send claims to Centers for Medicare Services for approval, when appropriate. Keeps abreast of Medicare changes.
- Identifies and investigates potential fraud and works with the Special Investigation Unit investigator to provide necessary documentation that may support a referral to the state. When required, provide legal testimony in support of cases that are being prosecuted.
- Provides requested updates to Management on high profile or high dollar claims.
- Prepare and present claims for Corporate Plan of Action meetings and Account Claim Reviews as requested.
- Performs other duties as may be dictated by office/department/corporate circumstances.
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.
Education:
Bachelor’s degree in Business Administration, Insurance, or closely related field preferred
Experience:
3 or more years’ experience handling Worker’s Compensation Claims required
Designations/Certifications:
AIC is preferred but not required.
AIM preferred but not required.
Our home office is located in vibrant Columbia, Missouri — #6 in Livability’s 2019 Best Places to Live. - 11 Days Ago
Claims Representative
- Missouri Employers Mutual
-
Normal, IL
FULL_TIME
- Are you driven to keep people safe? That’s what we do every day at Missouri Employers Mutual. We’ve created a casual, values-driven work culture that’s making a positive impact on the way people live ...
- 12 Days Ago
Claims Consultant (Remote)
- Missouri Employers Mutual
-
Normal, IL
FULL_TIME
- Are you driven to keep people safe? That’s what we do every day at Missouri Employers Mutual. We’ve created a casual, values-driven work culture that’s making a positive impact on the way people live ...
- Just Posted
Claims Consultant (Remote)
- Missouri Employers Mutual
-
Bloomington, IL
FULL_TIME
- Are you driven to keep people safe? That’s what we do every day at Missouri Employers Mutual. We’ve created a casual, values-driven work culture that’s making a positive impact on the way people live ...
- 1 Day Ago
Claims Support Specialist II
- Erie Insurance
-
East Peoria, IL
FULL_TIME
- At Erie Insurance, you’re not just part of a Fortune 500 company; you’re also a valued member of a diverse and inclusive team that includes more than 6,000 employees and over 13,000 independent agenci...
- 1 Day Ago
Claims Support Specialist II
- Erie Insurance
-
Peoria, IL
FULL_TIME
- Division or Field Office: Illinois Branch Office Department of Position: Claims Department Work from: Branch Office Salary Range: $31,300.00 - $49,998.00 * salary range is for this level and may vary ...
- 1 Month Ago
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0 Claims Analyst jobs found in Peoria, IL area
Underwriting/Operations Assistant - Personal Umbrella (Peoria, IL)
- RLI Corp.
-
Peoria, IL
- About Us We're not like other insurance companies. From our specialty products to our business model, our culture to our...
- 4/26/2024 12:00:00 AM
Insurance Sales Agent - Customer Service
- Freeway Insurance Services America LLC
-
Peoria, IL
- Sign-On Bonus Opportunity of up to $1,000* Pay Range: $15 - $17 / hour Our Perks: Unlimited/Uncapped commission Lucrativ...
- 4/26/2024 12:00:00 AM
Underwriting/Operations Assistant - Personal Umbrella (Peoria, IL)
- RLI Corporation
-
Peoria, IL
- Provide operational support for Personal Umbrella (PUP) products and programs as needed. Support PUP underwriting by cre...
- 4/25/2024 12:00:00 AM
Transportation Dispatcher - GROWMARK, Inc. - Bloomington, IL
- Growmark
-
Bloomington, IL
- ** Transportation Dispatcher - GROWMARK, Inc. - Bloomington, IL** GROWMARK is a regional cooperative with annual sales o...
- 4/23/2024 12:00:00 AM
Master Underwriter (Worker's Comp)
- Summit Holdings
-
Peoria, IL
- Job Description Job Description Job Description It’s one thing to know workers’ comp. It’s another to know people. But k...
- 4/23/2024 12:00:00 AM
Workers' Comp Senior Claims Specialist (Remote in Illinois)
- Summit Holdings
-
Peoria, IL
- Job Description Job Description Job Description It’s one thing to know workers’ comp. It’s another to know people. But k...
- 4/23/2024 12:00:00 AM
Document Management Analyst I
- Contact Government Services, LLC
-
Peoria, IL
- Document Management Analyst I Employment Type: Full Time, Entry-level Department: Legal Services Here at CGS, we are see...
- 4/22/2024 12:00:00 AM
Insurance Agency Owner
- AAA-The Auto Club Group
-
Peoria, IL
- AAA - The Auto Club Group, is seeking ambitious, business-minded, and visionary Entrepreneurial Agency Owners to join ou...
- 4/22/2024 12:00:00 AM
About Peoria, Illinois
Peoria (/piˈɔːriə/ pee-OR-ee-ə) is the county seat of Peoria County, Illinois, and the largest city on the Illinois River. Established in 1691 by the French explorer Henri de Tonti, Peoria is the oldest European settlement in Illinois, and is named after the Peoria tribe. As of the 2010 census, the city was the seventh-most populated in Illinois (and the third largest outside the Chicago metropolitan area), with a population of 115,007. The Peoria Metropolitan Statistical Area had a population of 373,590 in 2011. Until 2018, Peoria was the global and national headquarters for Caterpillar Inc.,...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Analyst jobs
$37,020 to $47,473
Peoria, Illinois area prices
were up 1.3% from a year ago
were up 1.3% from a year ago
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