TSGLI Claims Processor

Patriot Enterprises - San Antonio, TX

Full-time - Mid Level

San Antonio, TX

Specialty Trade Contractors

About the position

The Traumatic Servicemembers Group Life Insurance (TSGLI) Claims Processor plays a crucial role in supporting the Air Force Wounded Warrior (AFW2) Program. This position involves processing claims for servicemembers who have suffered serious injuries or illnesses, ensuring they receive the necessary information and entitlements as they transition back to civilian life or duty. The role requires strong knowledge of medical terminology and coding, as well as excellent communication and organizational skills to advocate for the needs of the claimants throughout their recovery and rehabilitation process.

Responsibilities

• Review and determine the completeness of claim applications and verify substantiating documentation.
• Process claims for comprehensive medical review based on eligibility requirements.
• Manage case files, including creating, maintaining, tracking, and archiving them according to policy and guidance.
• Assess medical review advisories and develop correspondence for claim approval or denial.
• Draft letters and correspondence explaining medical losses and the appeal process for claimants.
• Construct and review Staff Summary Sheets and other correspondence for higher-level review.

Requirements

• Bachelor's degree or relevant three to five years of experience in medical insurance claims processing.
• Strong knowledge of medical terminology and ICD-9/10 coding.
• Above average experience using Microsoft Office (Word, Excel, Outlook) and other applicable applications.
• Excellent communication skills, able to convey information in both professional and layman's terms.
• Strong analytical and problem-solving skills to assess needs and recommend solutions.
• Strong organizational skills to manage multiple priorities effectively.

Nice-to-haves

• Bilingual proficiency to assist a diverse range of claimants.
• Experience in casefile management and metrics reporting.

Benefits

• Life insurance