Claims Clerical Support at NEW ERA LIFE INSURANCE COMPANY – Houston, Texas

The Under 65 Claims Clerical Support Unit is responsible for entering and processing claims, ensuring timely turnaround (1-2 days), and reviewing claim submissions for discrepancies. Individuals on the team are flexible with their work and manage their time accordingly based on work needs.

Duties and Responsibilities:
Enter claim details into the processing system (such as claim number, policy number, total charge, service date, provider, patient, etc.) to prepare claims for review by the claims examiners

Identify and report discrepancies in claims (e.g., incorrect patient names, birthdates, etc.)

Maintain a 1-2 day turnaround time from claim receipt to claim management

Review and log claims/documents submitted through the Policyholder Portal, Agent Portal, and any other referred portals within the company

Report any discrepancies or issues with claim submissions to leadership

Communicate any issues related to the portals to leadership

Ensure claims are processed as quickly as possible, aiming for a one-day turnaround time

Sort and distribute incoming mail within the U65 claims department

Handle returned mail efficiently

In certain situations, make copies of received information and forward the mail to the appropriate department for further processing

Review and resolve claims in the SDS Eligibility Queue, which contains claims that the clearinghouse cannot match to the eligibility file (due to mismatched policy numbers, names, birthdates, or addresses)

Claims must be matched or closed if they cannot be verified Review and manage claims in the SDS Pended Rejected Queue, where claims are placed if they are incomplete or illegible (missing diagnosis codes, CPT codes, provider info, etc.)

Missing information should be added, or the claim should be closed, with a letter sent to the provider requesting the necessary details

Ensure that all queues are maintained with a 1-2 day turnaround time

Inform leadership of any unusual or complex cases/issues within the queues for appropriate handling instructions
Qualifications and Skills Required:

Excellent communications skills (Both verbal and written)

Basic Word and Excel skills

Able to prioritize duties and effectively manage time

Ability to be flexible when needed, take initiative, and demonstrate accountability

Ability to work well within a team environment and participate in department/team projects

Must be customer service oriented High School or GED

Legal rights to work in the US

Preferred:

Proficiency in Microsoft Office products

Equal Opportunity Employer:

New Era Life Insurance is an Equal Opportunity employer that strives to provide and maintain a work environment that fosters mutual respect, professionalism and cooperation. All qualified applicants will receive consideration for employment without regard to actual or perceived race, creed, color, religion, national origin, ancestry, alienage or citizenship status, age, disability or handicap, sex, gender identity, marital status, familial status, veteran status, sexual orientation or any other characteristic protected by applicable federal, state or local laws.