Independently adjudicate complex life and health claims, including contestable, accidental death, and accelerated death benefit cases.
Collaborate with claimants, attorneys, reinsurers, and internal teams to gather evidence and determine liability.
Analyze medical records, underwriting evidence, and investigative findings to make well-supported claim decisions.
Banner Life Insurance Company provides life insurance and financial protection products, focusing on long-term customer and community impact. The company values meaningful work, professional development, and a collaborative culture of ambition and wellbeing.
Investigate potential payment inaccuracies using Medicare Advantage claims and reimbursement knowledge to interpret data and explain payment outcomes.
Review claims populations identified through SQL analysis, distinguishing supported discrepancies from exceptions and correctly adjudicated claims.
Document validated findings clearly and support downstream recovery, Compliance/Legal review, and recurring audits.
Clover Health provides healthcare plans for seniors, using data and technology to improve care and lower costs. The company is a remote-first, mission-driven organization focused on diversity and inclusion.
Manage end-to-end drug prior authorization and claims cases, assessing requests against clinical guidelines and plan provisions.
Communicate authorization outcomes clearly to members, providers, and internal stakeholders while resolving escalated and complex scenarios.
Serve as a subject matter expert to support teams, training, and continuous improvement initiatives.
The hiring company operates in the insurance and benefits sector, managing complex drug prior authorization and claims cases. It is a global organization with a collaborative culture that values flexibility, continuous improvement, and employee well-being.