Claims Specialist II

Looking to join a growing company dedicated to helping others? We offer that, plus competitive salaries, a culture of learning, and a fast-paced environment. This is a hybrid position with 3 days in-office. Join our team to help make a difference in the lives of others! Applicants must be authorized to work for ANY employer in the U.S. We do not sponsor employment visas or other immigration processes to attain or maintain employment eligibility. Remote positions are open to applicants based anywhere in the continental U.S. Hybrid positions are open to applicants based in the Austin, Texas area. About Continental General The Continental General family of companies has provided insurance, including life and long term care policies, to individuals and groups for over 30 years, and currently supports over 200,000 policyholders. Both our insurance company, Continental General Insurance Company, and our third‑party administrator, Continental General Services, are committed to the continuous development of our infrastructure, processes, and people. The group is actively growing through expansion of both its insurance portfolio and its administrative services. With each opportunity, we take a collaborative approach to address challenges and provide unique solutions. Position Summary The Claims Specialist II provides responsive, customer‑focused support by handling claim requests and ensuring issues are resolved accurately and efficiently. They are responsible for delivering clear updates, answering questions, and working with internal and external partners to provide a smooth, professional experience for customers throughout the claims process. Key Responsibilities Processes and resolves moderately complex claim servicing requests, including check reissues, payment corrections, reversals/reservices, Refund of Premiums, Waiver of Premiums, and other claim‑related items in accordance with policy provisions and established procedures. Reviews claim details, payment history, system records, and supporting documentation to identify issues and determine appropriate resolution. Researches and analyzes complex claim servicing items, including payment discrepancies, overpayments, and account adjustments ensuring accurate and timely completion. Coordinates with internal departments, vendors, providers, insureds, and other appropriate parties to obtain information and resolve outstanding claim issues. Conveys simple to moderately complex information (coverage, decisions, outcomes, etc.) to all appropriate parties, maintaining a professional demeanor in all situations. Handles outbound claim related callbacks, addressing questions, providing status updates, and ensuring timely follow‑up and resolution. Ensures claims handling is conducted in compliance with applicable statutes, regulations and other legal requirements, and that all applicable company procedures and policies are followed. Identifies opportunities for process improvements and escalates complex or unusual issues to leadership for review and resolution. Performs other duties as assigned. Qualifications Associate degree or higher in business, insurance, healthcare administration, or a related field preferred; or equivalent years of experience. 3+ years of experience in insurance claims, long‑term care insurance, life insurance, health insurance, financial services, or a related field preferred. Demonstrated experience handling complex claim transactions, payment processing, adjustments, escalations, or customer inquiries. Experience interpreting policy provisions, researching claim information, and applying procedures and guidelines to resolve claim issues. Possesses demonstrated technical knowledge and skills, including product and industry knowledge, reflective of successful progression through various job family levels. Performs work under general supervision. #J-18808-Ljbffr