Enoah Isolutions Inc.

Job Title: Claims Examiner – Life, Accident, Critical Illness, LTC, and Hospital Indemnity Overview: As a Claims Analyst specializing in Accident, Critical Illness, Short-Term Disability, and Hospital Indemnity lines of business, you will be responsible for accurately assessing and processing claims related to these insurance products. Your role will involve investigating claims, verifying policy coverage, determining liability, and ensuring compliance with regulatory requirements. Strong analytical skills, attention to detail, and empathy are essential for this position as you will interact with claimants, healthcare providers, and other stakeholders to facilitate timely and fair claim settlements. Key Responsibilities: Claims Processing and Assessment: Evaluate incoming claims to determine eligibility, coverage, and validity. Conduct thorough investigations, including reviewing medical records and other relevant documentation. Analyze policy provisions and...

Interpret contract benefits accurately to policyholder, agents, and providers with a positive and professional approach. Provide claim status to policyholders or providers with a positive and professional approach. Answer calls as required by company policy in a helpful, professional, timely manner. Place outgoing calls as needed to provide or obtain information. Document (written/on-line) all calls while in progress. Transfer calls to employees in other departments as required to meet customer needs. Fully document policy file or imaging system with all related material so as to leave a clear and concise audit trail. Actively participate in cross training and group training sessions to maximize team efficiency and maintain or exceed service standards. Communicate openly with Supervisor, Team Lead and other team members to ensure accurate responses and avoid duplication of efforts.