• Responsible for the accurate and timely processing of medical, dental, vision and prescription drug claims. • Provide courteous and prompt responses to customer inquiries. • Communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public. • Verifies the accuracy and receipt of all required documentation for each claim submitted. • Collaborates with providers, plan participants, other claims payers, or any other party necessary to obtain information necessary to accurately process a claim. • Analyzes information necessary for processing. • Assures that the system processes the claim correctly and determines payment according to the plan as written. • Answers telephone calls from plan participants, group contacts, and customer service representatives pertaining to benefits and claims inquiries. • Resolves problematic claims with the assistance of the Team Leader, Claims Manager and/or the Director of Claims. • Assigns critically ill patients to large case management. • Assists other examiners as needed due to workload requirements, including assigned back-up when examiners are absent. • Aids the Team Leader and/or the Claims Manager in the resolution of claim appeals and disputes by providing documentation for review. • Researches, calculates and requests refunds when necessary. • Contributes to the daily workflow with regular and punctual attendance. • Thoroughly researches and completes renewal reports in a timely manner in consultation with the Marketing Department. • Process eligible claims on groups before the end of their stoploss contract renewal period. • Assists the Legal Department with subrogation claims as necessary. • Attends various group meetings as required. • Assists with audits as needed. • Assists with plan benefit set-up and changes as needed.