Associate Claims Examiner or Claims Examiner - 1152

Job Description

Job Description

As an Associate Claims Examiner, you will be responsible for developing proficiency in the handling of all aspects of the claim process for assigned claims. This position will learn to process claims, receive and maintain reports, guide beneficiaries through the claim process, file for reinsurance, and provide customer service to internal and external customers.

As a Claims Examiner , you will also be responsible for evaluating and processing disability claims for payment or denial according to the terms and conditions of each policy.

The level of the position will be determined by relevant skills, experience and qualifications. 

 

This position may offer flexibility through a telecommuting arrangement and can be performed from either the Greater Houston or Greater Binghamton area. If you reside in the Greater Houston or Greater Binghamton area, this may be an opportunity for you! 

Description of Duties & Responsibilities:

• Review submitted claims to ensure proper guidelines have been followed and eligibility requirements have been met. Contact policyholders, beneficiaries or other third parties for missing information when required. Process claims for payment or denial.
• Participate in rotational, scheduled queue call handling and dedicated client telephone calls and respond accordingly. Reply to basic inquiries and assist callers in understanding claims requirements and decisions.
• Process assigned claims through claims processing systems. Create new claims files and input claims data and payments into applicable systems as necessary.
• Process and distribute paper and electronic mail and/or faxes received including but not limited to logging data in appropriate systems and distributing to appropriate areas and/or virtual folders for processing.
• Prepare claims documents for imaging. Process must be thorough and accurate to keep within guidelines for statutory file maintenance.
• Follow-up on outstanding requirements according to established guidelines to enable the department to comply with regulatory and state requirements. Distribute claim documents to assigned claim examiner.
• Assist with claims account reconciliation as needed.
• Provide back up support to other staff as needed.

Additional Duties & Responsibilities of a Claims Examiner:

• Provide total quality customer service and support to all internal and external customers in regards to assigned functions. Provide professional communications including but not limited to written correspondence, phones, email, fax and in-person interactions.
• Investigate claims. Search database to obtain background information and interview claimants and witnesses. Consult police, hospital records and policy files to verify information reported in a claim. Consult with other professionals, such as lawyers and physicians, on complex claims.
• Assist in handling claims with suspected fraudulent or criminal activity. Access personal information and past claims histories to establish whether a claimant has ever attempted insurance fraud.
• Address inquires on assigned claims from various parties including but not limited to insured, policy holders, agents, physicians, hospital attorneys, Workers' Compensation Board, Workers' Compensation carriers, State agencies, other insurance carriers, TPA's, Reinsurers and internal staff.
• Analyze various individual and departmental claim reports and take appropriate action on identified cases as prioritized by management.
• Set-up incoming claims and process daily mail to ensure approved time standards for processing are met. Ensure required follow-up is completed and claim processing is resolved within time guidelines mandated by state and federal regulations as well as required internal standards.

Skills & Experience: 

• 2-3 years of related experience required.
• 1-2 years life insurance experience required.
• Experience in a customer service or insurance industry environment required.
• Familiarity with medical terminology and Company products is strongly preferred.
• Intermediate experience with Microsoft Excel required.
• Basic experience with Microsoft Word required.
• Industry recognized certifications preferred.

Additional Skills & Experience of a Claims Examiner:

• 3-5 years of related experience.
• 3-5 years life insurance experience required.
• Administration experience required.
• Experience with Sigma, E-Records, Life Support Plus, Freedom, and Lotus Notes are strongly preferred.

 

Education Required:  Associate’s degree in business required. Degree in related field of study is acceptable.

Pay Range for an Associate Claims Examiner: $20.74 to $24.00 hourly 

Pay Range for Claims Examiner: $22.42 to $26.00 hourly

 

The starting pay rate for this role is based on a variety of relevant factors, including location, education, experience, and skills.

 

Visa sponsorship is not available for this position

Relocation assistance is not available for this position

Security Mutual is an Equal Opportunity Employer

About SML:

Security Mutual Life is a leading provider of life insurance, accumulation products and retirement-, business- and estate-planning services for individuals, families and businesses. Our innovative products help our clients meet their financial protection needs. Headquartered in Binghamton, New York, the Company was founded in 1886 and is recognized for its longstanding history of financial strength and stability.

We continually invest in technology. Our agents and employees are equipped with the latest tools and deliver outstanding service to our hundreds of thousands of policyholders throughout the United States.

We are committed to our neighbors and communities. Security Mutual and its employees help support a wide variety of community and charitable initiatives and organizations through our donations and service.

At Security Mutual our employees are among the Company’s most valued assets. We offer competitive salary and benefits and our work environment reflects the Company’s core values of trust, respect and integrity.

Federal & State Labor Law Posters