Claims Payer

Description

Who we are:

Since 1956, Lewer has served as an advocate for independent business owners who seek to protect what they’ve built and prepare for the future. In 1991, our student division was formed to protect people around the world.

Lewer offers a concierge approach to employee and student insurance by providing tailored benefit strategies designed to create healthier businesses, families, and individuals.

What you'll do at Lewer: 

Role and Responsibilities

As a Claims Payer, your performance has a significant impact on the organization’s financials, customer satisfaction, compliance and regulatory risks, operational efficiency, data management, and provider relationships. You have a direct impact on the lives of claimants by accurately evaluating and processing their claims. Your attention to detail, analytical skills, and commitment to excellence will ensure that claims are processed efficiently, members are treated fairly, and compliance with regulations is maintained. By providing exceptional client service and collaborating with internal and external stakeholders, you contribute to resolving claim issues and disputes, ultimately helping members receive the benefits they are entitled to.

Your Key Areas of Impact 

Financial Impact: Claims payments represent a significant portion of an organization's expenses, and as a Claims Payer, you directly impact the financial health of the organization. Accurate and efficient claims processing and payment can help control costs, minimize loss ratios, and maintain profitability.

Client Satisfaction: Claims processing is a critical touchpoint with clients and healthcare providers, and your performance can greatly impact their satisfaction. Prompt and accurate claims payments can help build trust, enhance client loyalty, and maintain positive relationships with policyholders and providers.

Operational Efficiency: Claims processing involves complex administrative tasks, including verification, adjudication, and payment of claims. Efficient claims payment processes, accurate coding, and streamlined workflows can result in improved operational efficiency, reduced administrative overheads, and faster claims processing times.

Data Management: Claims payment involves handling large volumes of sensitive data, including policyholder information, medical records, and financial transactions. Proper data management practices, including data security, privacy, and accuracy, are crucial to protect the organization and its stakeholders from data breaches, fraud, and reputational damage. You play a significant role in ensuring proper data handling practices are in place to safeguard the organization's data assets.

Provider Relationships: You interact closely with healthcare providers, including hospitals, clinics, and individual practitioners. The timeliness and accuracy of claims payments can greatly impact the relationships with these providers. Building and maintaining positive relationships with providers is important for the organization's network adequacy, provider satisfaction, and collaboration, which in turn can affect the organization's reputation and market competitiveness.

Cross-Functional Collaboration: Your collaborative approach in working with various internal and external stakeholders is vital to the organization's success. Your effective communication skills, relationship-building, and teamwork foster a culture of collaboration and enable successful partnerships, benefiting the organization's overall business objectives.

You have a commitment to cross-training and serving as backup for your colleagues as needed, which drives smooth operations and superior service for all Lewer clients.

Your qualifications:

Requirements

You’ve received your bachelor’s degree from an accredited university in healthcare, business, or education, and you’ve spent time in medical claims adjudication and client care roles that have helped you develop excellent analytical skills. You are proficient with Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook. You are also proficient with claims management systems. You hold a life and health insurance license or will after 90 days of hire.

The Work Environment, Physical Demands, and Travel

Your work is conducted primarily at the Lewer Administrative Offices. On occasion, your work may be conducted at a remote location, such as a home office. You must be able to remain in a stationary position 75% of the time, and be able to occasionally move about inside the office to access filing cabinets, office machinery, etc. You will operate a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer 95% of the time. You will need to be able to lift to 20 lbs. Travel is required for this seat and is less than 5%.

More about us:

Our Core Values

You live the following “Lewer Core Values” in your daily work:

I've Got This - Always takes care of business; assumes responsibility, supports accountability, leads by example.

Kaizen - Embodies constant improvement; always asks why and continuously improves our processes.

Results With Integrity - Commits to strong moral and ethical principles in the pursuit of excellence.

Good Vibes - Takes care of one another; works enthusiastically, treats others professionally and respectfully.

The Team

Lewer runs on the Entrepreneurial Operating System (EOS). That means as a member of this team, your manager is committed to:

• Giving clear directions.
• Providing the necessary tools.
• Acting with the greater good in mind.
• Delegating.
• Understanding your role and how you can help the company.
• Providing clear expectations.
• Communicating effectively.
• Running effective meetings.
• Meeting one-on-one with you quarterly or more, if needed.
• Rewarding and recognizing your performance.

It also means you are committed to the EOS life by doing what you love, with people you love. You make a huge difference, are compensated appropriately, and take time to pursue personal passions.