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Claims Adjuster

Expired Job

CNO Financial Group Chicago , IL 60602

Posted 3 months ago

Job Title

Claims Adjuster

Location

Chicago, IL

Job Details

  • Identify and gather claim material necessary to determine initial claimant and provider eligibility

  • Review and interpret claim information, including but not limited to medical records, daily visit notes, benefit eligibility assessments, to formulate an appropriate understanding of claimant condition and care needs

  • Investigate, analyze and correlate all relevant material and facts to determine appropriate action based on company records, including claim files, system data and information verbally obtained from the policyholder, legal guardian, and / or provider(s)

  • Interpret insurance policy language and apply initial claim processing procedures to both standard and unique claim situations

  • Exercise critical thinking and judgment to appropriately conclude benefit eligibility decisions

  • Present claim eligibility recommendations to various committees, providing clear rationale for recommendation

  • Strong communication skills, written and verbal, to communicate policy provisions, requirements, and claim determinations to claimant and/or legal guardian(s)

  • Efficiently navigate workflow, claim management, and record keeping systems

  • Effectively manage time to meet department set production goals and maintain quality standards

  • Present all denial cases to the Claim Review Committee, providing clear rationale for recommendation

  • Appropriately refer all Tax-Qualified Chronically Ill Certifications to a Licensed Healthcare Practitioner (LHCP) for review and sign-off

CNO Financial is an Equal Opportunity Employer and Affirmative Action Employer. For more information, please click the following link

Equal Employment Opportunity is the Law (English)

Equal Employment Opportunity is the Law (Spanish)

Right to Work Poster (English)

Right to Work Poster (Spanish)


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Claims Adjuster

Expired Job

CNO Financial Group