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Advanced Claim Examiner

Physicians Mutual Omaha, NE

Job Description

Physicians Mutual is looking for an Advanced Examiner in our Claims area. This person will evaluate and respond to claim service requests for the Companies' customers, providers and entitled parties. Analyze claim forms, medical records and bills to adjudicate underwritten cancer, health, life and/or Medicare Supplement. Corresponds with Policyowners, doctors, hospitals and other interested parties via phone, dictation and free form letters to collect necessary data to properly determine if customer claim for benefits is within the scope of the insurance contract. Processes payment or explains claim decision to customer through appropriate communication channels. Recognizes and refers complex claim situations to appropriate area for possible settlement. Maintains maximum focus on customer service throughout all stages of claim evaluation. 

Job Qualifications

  • Good communication skills are necessary to effectively correspond with policyowners, or other entitled parties.

  • Advanced knowledge of medical conditions and the relationship between etiology, symptoms, complications and related health care procedures.

  • Thorough understanding of contestable policy provisions, amendment rider limitations, underwriting guidelines, claim procedures, state insurance regulations and concepts relating to underwritten coverages.

  • Detailed knowledge of multiple product kinds, i.e. Hospital Indemnity policies; benefit riders; Medicare Supplement policies, HMS/CAT and Life policies.

  • Ability to operate a PC and all applicable programs and applications.

  • Effective problem solving' decision-making and organizational skills; high level of attention to detail.

  • Basic math needed to calculate benefits and interest.

  • Good working knowledge of the function of other departments and their relationship to the claims process.

  • Ability to learn quickly and adapt to new insurance coverages, procedures and guidelines.

  • Ability to handle difficult and complex claim situations.

  • Ability to function effectively in a production environment with high quality work.


Company Overview

Physicians Mutual Insurance Company and Physicians Life Insurance Company are members of the Physicians Mutual family. Physicians Mutual Insurance Company offers reliable Medicare Supplement, dental and supplemental health insurance. Physicians Life Insurance Company provides important life insurance coverage and annuities. In 2012, they entered the funeral pre-planning market to help meet the growing needs of funeral home owners and the families they serve. The companies have more than $3.8 billion in assets and consistently maintain some of the highest financial strength ratings in the nation from independent insurance analysts, including A.M. Best Company and Weiss Ratings.


Founded in 1902, Physicians Mutual is headquartered in Omaha, Neb. To learn more about the company, please visit www.PhysiciansMutual.com.


Job Details

Date Posted November 16, 2018
Date Closes January 15, 2019
Requisition 311018.2
Located In Omaha, NE
SOC Category 00-0000.00