Claims Examiner- Voluntary Benefits

TheVoluntary Benefits Claims Examiner will support a large Group Insurance Business contract is responsible for the calculation of Voluntary Benefits across limited products according to Plan Provisions.  Voluntary Benefits can include wellness, hospital indemnity, accident and critical illness products.  This position requires the knowledge and understanding of Voluntary Benefits policies and procedures with a medical terminology background and ability to read medical records outside of ICD’s, CPTs and HCPC to appropriately calculate the benefits due. You will be expected to follow through timely on claim processing, utilize judgment, and assess risk when rendering claim decisions. Able to communicate with various constituents with limited guidance and learn and transact using the client s systems. Expected to communicate clearly concisely to influence return to work, discuss terms of the certificate, and the basis of payment nonpayment.

Key Responsibilities:

• Document all claim information including phone calls and correspondence.

• Utilize effective communication to obtain information both verbally and in writing and provide information to the claimant and employer.

• Ability to read multiple pages of medical records to confirm benefits available to the member.

• Ability to apply plan provisions understand the needs of the clients.

• Expected to adhere to client Service Level Agreements and department s product s key performance requirements and any reporting.

• Able to utilize strong organizational skills to manage multiple priorities while working under tight time constraints, possess the ability to work through ambiguity, and work effectively with various vendors with strong interpersonal skills.

• Willing to support special internal functional projects and ad hoc requests as required.

• Able to work cohesively with Subject Matter experts to support the day to day tasks, able to anticipate, identify, and resolve complex issues problems.

• Able to communicate risks issues to supervisor and help with the resolution, as needed.

• Provide exceptional customer service either over the phone or through email.

• Able to provide leadership updates progress reports on training curriculum.

• Utilize tools independently and accurately to identify work to be completed.

• Professional and detailed verbal skills for outbound calls to obtain medical records or claim details to gather data to work claim to completion.

Basic Qualifications:

• Minimum of 6 months experience in Medical Insurance Claims Processing

• Minimum of 1 year experience in a contact center/call center.

Preferred Qualifications:

• Group Life/Disability/ Voluntary Claims experience

• Bachelor s Degree

• NY Adjustor License

• Strong mathematical skills

Professional Skills:

• Proficiency in Windows environment, including Word and Excel

• Medical terminology knowledge

• Strong written and verbal communications required

• Detailed oriented with strong time management skills

Job Requirement:Schedule flexibility to work a schedule from 7 am to 7 pm CST

Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience. As required by local law, Accenture provides a reasonable range of compensation for roles that may be hired as set forth below.We anticipate this job posting will be posted until 08/28/2026.Accenture offers a market competitive suite of benefits including medical, dental, vision, life, and long-term disability coverage, a 401(k) plan, bonus opportunities, paid holidays, and paid time off. See more information on our benefits here:

U.S. Employee Benefits | Accenture

Role Location Hourly Salary RangeCalifornia $21.68 to $40.53Cleveland $20.10 to $32.40Colorado $21.68 to $35.00District of Columbia $23.13 to $37.26Illinois $20.10 to $35.00Maine $18.51 to $29.81Maryland $21.68 to $35.00Massachusetts $21.68 to $37.26Minnesota $21.68 to $35.00New York $20.10 to $40.53New Jersey $23.13 to $40.53Virginia $20.10 to $37.26Washington $23.13 to $37.26

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