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Life & Health Claims Examiner

4 months ago

Addison, United States Horace Mann Full time
(Hybrid) Addison, TX

Hybrid work position for a Claims Examiner responsible for set-up and processing claims while providing exceptional quality service in a timely manner in an effort to build customer satisfaction and loyalty

Essential Functions
  • Link and set-up Wellness and Physician consult claims in the work distribution system and policy administration system.
  • Responsible for evaluating claims submitted, comparing the provisions of the policy and applicable laws with submitted information to accurately adjudicate the claim.
  • Responsible for providing claimant necessary forms, instructions, reasonable assistance of information the claimant must provide for proof of claim.
  • Types letters for request of medical and/or other necessary information relevant to the claim analysis.
  • Responsible for timely requests, follow-ups and closeouts on claims submitted.
  • Responsible for maintaining claim files up to standards with the Fair Claims Settlement Practice Regulations.
  • Communicates with policyholders, beneficiaries, and/or health care providers concerning claim handling, claim denials, claim payments and policy contract provisions in a caring, courteous, empathetic, and professional manner.
  • Process for payment, denial or request additional information for Wellness, Physician Consult benefits, group and substantive products.
  • Existing knowledge of medical terminology, diseases, conditions and treatments applicable to our product lines.
  • Process for payment, denial or request information for multiple substantive and group product maintaining satisfactory monthly performance rates
  • Performs other duties as assigned.
Experience and Education
  • 2 or more years' claim experience in life/health claims or a related field
  • High School Diploma or GED required.
  • Bachelors' degree preferred.
Job Requirements
  • Some LOMA or AHIP classes completed or a willingness to take the classes
  • Ability to type 40 words per minute minimum
  • Working knowledge of Microsoft Outlook, Word and Excel
  • Strong written and verbal communication skills
  • Ability to prioritize tasks
  • Excellent organizational skills

#LI-TD1

#VIZI#

#IND

Horace Mann was founded in 1945 by two Springfield, Illinois, teachers who saw a need for quality, affordable auto insurance for teachers. Since then, we've broadened our mission to helping all educators protect what they have today and prepare for a successful tomorrow. And with our broadened mission has come corporate growth: We serve more than 4,100 school districts nationwide, we're publicly traded on the New York Stock Exchange (symbol: HMN) and we have more than $12 billion in assets.

We're motivated by the fact that educators take care of our children's future, and we believe they deserve someone to look after theirs. We help educators identify their financial goals and develop plans to achieve them. This includes insurance to protect what they have today and financial products to help them prepare for their future. Our tailored offerings include special rates and benefits for educators.

EOE/Minorities/Females/Veterans/Disabled. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status

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