Traumatic Servicemembers Group Life Insurance (TSGLI) Claims Processor

　　The Air Force Wounded Warrior (AFW2) Program works with the Air Force Survivor Assistance Program, Airman & Family Readiness Centers, and the Air Force Medical Service to provide concentrated non-medical care and support for combat wounded, ill and injured Airmen (and their families) as they recover and transition back to duty or into civilian life.

　　Traumatic Servicemembers Group Life Insurance (TSGLI) Claims Processor

　　The Air Force Wounded Warrior (AFW2) Program is in support of the Office of the Secretary of Defense (OSD) to ensure all seriously and very seriously Wounded, Ill and/or Injured (WII) medically separated members or returned to duty of the Department of Defense (DOD) receive complete information and entitlements, the Components developed procedures to assist WII in transitioning back into the civilian sector or to duty. The AFW2 Program includes all Airmen who suffer a serious or very serious injury or illness and require long-term care and assistance. The AFW2 CMs contact, monitor, provide web-based information/resources, and advocate for the W2 from the time of hospitalization, through recovery and rehabilitation, and for as long as needed after separation and retirement. The completion of this task ensures that each AFW2, his or her family and/or caregivers receives personalized service (face-to-face) during the recovery, rehabilitation, and reintegration process, and total advocacy on his or her behalf during the transition process.

　　Job Duties:

　　Has strong knowledge and understanding of medical terminology and ICD 9/10 codes.

　　Able to review and determine claim applications are complete, meet initial eligibility requirements, and can verify all substantiating documentation covers the claimed losses to process claims for comprehensive medical review.

　　Knowledgeable in casefile management; creating, maintaining, tracking, metrics reporting and archiving case files by following guidance, policy, and checklists.

　　Able to assess medical review advisories and develop correspondence for approval/denial of medical insurance claims.

　　Has strong expertise to draft letters and correspondence explaining medical losses. evaluated, why losses were approved or not approved, and the steps for the claimant to appeal a decision based on VA and local procedures.

　　Able to construct and review Staff Summary Sheets, letters, emails, and other correspondence in order to submit for higher level review or provide responses to inquiries.

　　Required Skills Qualification:

　　Has above average experience using Microsoft Office software (Word, Excel, Outlook) and applicable applications (Adobe, Internet, Medical Systems) to conduct work.

　　Has excellent communication skills and is able to speak both professionally and in layman’s terms to claimants with disabilities, in order for them to understand their eligibility and/or decision statuses.

　　Strong analytical and problem-solving skills to access needs and recommend solutions.

　　Strong organizational skills.

　　Must be able to effectively support multiple, concurrent priorities.  

　　Required Education Level:

　　Bachelor’s degree

　　          OR

　　Relevant three to five years of work experience in assessment, development, and execution with regards to reviewing and processing a person’s medical insurance claim, assisting Registered Nurse and/or Physician’s Assistant / Nurse Practitioner with non-clinical administration of claims reviews to determine initial eligibility for Wounded Warriors and families that apply for TSGLI claims.

　　Our Equal Employment Opportunity Policy:

　　Patriot Enterprises is an equal opportunity employer. We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, veteran status, or any other basis protected by applicable federal, state or local law.

　　Physical Requirements:

　　The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

　　Physical requirements can typically be characterized as sedentary: work involves exerting up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.

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