UHY Advisors, Inc Claims Examiner/Processor (Veteran Services) Remote · Part time

Apply for Claims Examiner/Processor (Veteran Services)

The Claims Examiner/Processor is responsible for reviewing and processing claims submitted by veterans or their dependents for various benefits and compensation. This role ensures that claims are processed accurately, efficiently, and in compliance with relevant regulations, policies, and guidelines. The position involves direct interaction with veterans, reviewing their records, verifying documentation, and determining eligibility for various services and benefits.

Key Responsibilities:

1. Claims Review and Evaluation:

• Examine and assess claims submitted by veterans or their beneficiaries for various benefits, including disability compensation, pension claims, healthcare, and educational benefits.
• Verify eligibility by reviewing military service records, medical documentation, and other supporting materials.
• Analyze medical records, statements, and other evidence to determine claim validity and degree of disability or other eligibility factors.
• Ensure claims are processed according to applicable laws, guidelines, and internal policies.

1. Claims Processing:

• Process incoming claims accurately and within designated timeframes.
• Input data into the claims processing system and maintain up-to-date records of claims status.
• Communicate with veterans or their representatives to request additional documentation or clarification if necessary.
• Issue final decisions on claims, including approval, denial, or need for additional evaluation, based on evidence and regulatory standards.

1. Decision Making:

• Make recommendations regarding claim outcomes based on evidence, regulations, and established criteria.
• Determine the appropriate level of benefits or compensation due to veterans or their dependents.
• Ensure that decisions align with the goals of improving the veteran's quality of life while remaining compliant with federal and state regulations.

1. Customer Service and Communication:

• Serve as a point of contact for veterans seeking clarification about their claims, eligibility, and benefits.
• Provide guidance to veterans on the claims process, helping them understand documentation requirements and timelines.
• Communicate decisions to veterans and assist them in the appeals process if their claims are denied.
• Maintain professionalism and sensitivity when interacting with veterans, especially when delivering decisions related to disability or denied claims.

1. Documentation and Reporting:

• Document all actions taken on claims, including reviews, correspondence, and final decisions.
• Prepare and submit regular reports on claim status, pending claims, and resolved cases for review by senior staff or supervisors.
• Ensure that all claims are in compliance with internal audit processes and regulatory standards.

1. Compliance and Continuous Improvement:

• Stay current with changes in laws, regulations, and policies related to veterans’ benefits, claims processing, and related services.
• Participate in training and workshops to improve knowledge of veterans' benefits and enhance claims processing accuracy.
• Participate in audits and assist in resolving discrepancies or issues identified during quality control checks.

Qualifications:

Education and Experience:

• Bachelor's degree in a related field (e.g., business administration, public policy, or healthcare administration) is preferred.
• 2+ years of experience in claims processing, insurance, or benefits administration. Experience with veteran services or government programs is highly preferred.
• Knowledge of veteran benefits (disability compensation, pension programs, healthcare services) and familiarity with military service records is beneficial.

Skills and Abilities:

• Strong attention to detail and the ability to analyze and interpret complex medical, legal, and financial documents.
• Excellent communication skills, both written and verbal, to interact effectively with veterans, their families, and internal teams.
• Ability to work independently and prioritize multiple claims in a fast-paced environment.
• Proficiency in using claims management software and MS Office Suite (Excel, Word, PowerPoint).
• Strong organizational skills and the ability to manage and track numerous claims simultaneously.

Other Requirements:

• Knowledge of relevant laws (e.g., Veterans Benefits Administration (VBA) guidelines, Federal Regulations).
• A high level of empathy and professionalism when working with veterans, understanding their unique circumstances and challenges.
• Must pass a background check and potentially undergo a security clearance process (if required by the employer, especially for government roles).

Desirable Qualities:

• Veteran Status or familiarity with military terminology and veteran-specific issues can be a significant advantage.
• Previous experience in Veterans Affairs or with organizations supporting military personnel is highly preferred.
• Problem-solving skills to identify issues in claims and propose solutions.
• Ability to manage emotionally charged situations with understanding and patience.

Work Environment:

• Location: Often remote, though some roles may require periodic visits to veteran offices or service centers.
• Schedule: Full-time position with the possibility of flexible hours depending on the employer (government agencies may have standard office hours).
• Travel: Occasional travel may be required for training or on-site visits, but many positions are remote.

Compensation:

• Compensation varies based on location, level of experience, and the organization.
• Typical benefits may include healthcare, retirement plans, and paid time off. Some organizations may also offer additional benefits specific to veterans, such as veteran-specific health programs or wellness support.