SB Claims Examiner

Symetra offers a thrilling chance to become part of our group as a SB Claims Examiner!

About the role

The Claims Examiner is responsible for accurate and timely adjudication of complex professional, facility, and ancillary claims. This role makes timely, accurate, and customer-focused claim decisions for supplemental health products that may include limited benefit medical (LBM), critical illness, hospital indemnity, scheduled or group accident, and/or minimum essential coverage (MEC) products. Proactively reach out to internal and external sources to gather relevant medical, financial, legal, and/or general data, compare it to the applicable contract and procedural documents, conduct an analysis, and engage peers and management as appropriate. Communicate verbally and in writing and fully leverage the claim system with accurate and comprehensive information. Maintain performance within departmental metrics. The level of independent judgement assigned to this position increases over time.

What you will do

• Provide timely, accurate, and client-centered claim resolutions. Contact necessary parties to obtain information on a claim-by-claim basis. This process could involve engaging with healthcare providers, being responsible for coordination of benefits (COB) claims, and processing group benefits for claimants holding multiple coverage types.


• Review the information against the terms, limitations, and conditions of the contract and applicable procedural documents and provide the claim decision as promptly as possible. Record the claim systems accurately and comprehensively while ensuring maximum efficiency.


• Prepare and present clear written and verbal communication to various internal and external groups. Develop, revise, and implement a claim management plan to achieve the most appropriate result.


• Adhere strictly to regulatory requirements. Show proficiency in supplemental health products and claim processing techniques. Maintain alignment with operational standards. Achieve or surpass claim team operational goals.


• Maintain a superior level of genuine caring and empathetic customer service throughout all interactions. Take appropriate actions to earn the claimant’s and employer’s trust and confidence. Quickly resolve issues or concerns with payments, voids, refunds, and re-pricing issues.


• Support one another by working flexibly and collaborating. Foster a positive work environment while maintaining professionalism and integrity. Take active steps to improve morale and demonstrate dedication to excellence. Perform additional special projects or tasks as assigned by the Sr. Unit Manager.

Why Work at Symetra

Here’s what some of our employees share about why they choose to work at Symetra:

“I chose Symetra because I heard it was a pro-employee company—and it’s absolutely true. The work environment is supportive, the people are great, and the benefits are generous. Symetra truly cares about its employees. The relaxed atmosphere and opportunities to learn and grow—both within your role and beyond—make it a great place to build your career.” - Alicia L., Claims Examiner

What we offer you

Benefits and Perks

We don’t take a “one-size-fits-all” approach when it comes to our employees. Our programs are built to make your life better both at work and at home.

• Flexible full-time or hybrid telecommuting arrangements.


• Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6%.


• Paid time away including vacation and sick time, flex days and ten paid holidays.


• Give back to your community and double your impact through our company matching.


• Want more details? Check out our Symetra Benefits Overview.

Compensation

Hourly Range: $22.38 - $37.32 plus eligibility for annual bonus program.