Supplemental Claims Examiner

The next part of your journey is right around the corner — with The Standard.

A genuine desire to make a difference in the lives of others is the foundation for everything we do. With a customer-first mindset and an intentional focus on building strong teams, we've been able to uphold our legacy of financial stability while investing in new, innovative technologies that support the needs of our customers. Our high-performance culture focused on operational excellence thrives thanks to remarkable people united by compassion and a customer-first commitment. Are you ready to make a difference?

Job Summary

This position is accountable for successfully adjudicating and processing claims related to supplemental insurance products.  Focused on securing and analyzing information for supplemental insurance claims and completing the claim from intake, verification, adjudicating and payment. This position will approve decisions and payments; develop and apply appropriate claim management strategies to ensure prompt and accurate payment; and manage claims while providing responsive and caring customer service to claimants, policyholders, and others. Drive and own problem resolution for customers and internal partners through claims completion.  Utilizes every customer interaction to build trust with our customers by improving their experience with our products and services.  Brings voice of the customer and knowledge of customer problems, needs and desires to continuous improvement problem solving initiatives.  Able to manage and maintain effective working relationships with a variety of stakeholders (employers, brokers, TPAs, claimants).

Principal Duties & Responsibilities:

• 30% Claims submission and Communication. Claims intake, including portal and paper submissions; claims review, type creation, and in-good-order checks; communication of claims status (NIGO or closing claim, etc.). Provide accurate and appropriate claim information to claimants, policyholders, sales offices, and other interested parties; resolve issues through effective oral and written communication. Analyze, research, and respond to questions and issues, involving the appropriate people within, or outside the department or company.

• 30% Eligibility verification and claim adjudication. Confirming key data and product coverage components. Gathering medical inputs on eligible components; payable component calculations and reviews; communicating to financial services and claimant on claim status. Investigate, secure, and analyze information pertaining to the insured status and other policy provisions to accurately determine eligibility for and entitlement to supplemental benefits; identify discrepancies and outstanding issues and secure additional documentation as needed while investigating within prescribed timeframes and service expectations. Make and communicate decision and issue correct benefits for new and continuing claims.

• 30% Claim Payment. Completing the payment process including securing distribution, authorizations, verifying EOB, mailing claim payment. Managing the misplaced and lost check process including initiating stop pay process and requesting new payment. Develop and execute claim management strategies for each claim to appropriately contain claim liability and provide responsive and caring customer service; ensure claims are managed to the correct payment and that the company's financial liability is accurately established by identifying all applicable deductible income and maintaining accurate claim payment and system data.

• 10% Continuous improvement.  Brings voice of customer forward and solve for the customer experience first in every decision.  Collaborates with teammates to create a customer-first structure that enables new ways of working and facilitates clear lines of accountability that minimize customer-handoffs. Takes ownership of continuous improvement efforts to improve processes and solve problems.  Escalates problems as appropriate.

• Applies acquired job skills and working knowledge to lead the production of deliverables with multiple parties; analyzes work processes and develops, recommends and owns workflow improvements; determines business requirements; creates procedural documentation; identifies and facilitates resolution of issues; works effectively and with a diverse group of internal and external customers. 

Skills and Background You'll Need

• 1-3 years of related experience.

• Previous claims experience preferred.

• Strong proficiency with Windows and Microsoft Office applications (Word, Outlook, Excel, PowerPoint)

• Education: High School Diploma

Key Behaviors of a Successful Candidate

• Adaptability: Recognizes and is open to changing circumstances and alters behavior as necessary.

• Improvement Mindset: Continually seeks new ways to apply digital and non-digital solutions to drive innovation, efficiency, effectiveness and transformation to create business/customer value.

• Driving Success:  Takes action, initiates activity, pursues ambitious goals with persistence and shows resilience in the face of obstacles and setbacks.

We have built an enduring legacy of stability, financial strength and exceptional customer service through the contributions of the service-oriented people who choose to work at The Standard. To ensure we can attract and retain the best talent, when you join The Standard you can expect:

• A rich benefits package including medical, dental, vision and a 401(k) plan with matching company contributions

• An annual incentive bonus plan

• Generous paid time off including 11 holidays, 2 wellness days, and 8 volunteer hours annually — PTO increases with tenure

• A supportive, responsive management approach and opportunities for career growth and advancement 

• Paid parental leave and adoption/surrogacy assistance

• An employee giving program that double matches your donations to eligible nonprofits and schools

In addition to the competitive salary range below, our employee-focused benefits support work-life balance. Learn more about working at The Standard.

• Eligibility to participate in an incentive program is subject to the rules governing the program and plan. Any award depends on a variety of factors including individual and organizational performance.

The actual compensation for this role will be based on a combination of education and experience, knowledge and skills, position budget, internal equity, and market data.

Salary Range:

Positions will be posted for at least 5 days from original posting date.

Standard Insurance Company, The Standard Life Insurance Company of New York, Standard Retirement Services, Inc., StanCorp Mortgage Investors, LLC, StanCorp Investment Advisers, Inc., and American Heritage Life Insurance Company and American Heritage Service Company, marketed as The Standard, are Affirmative Action/Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, religion, color, sex, national origin, gender identity, sexual orientation, age, disability or veteran status or any other condition protected by federal, state or local law. Except where precluded by state or federal law, The Standard will consider for employment qualified applicants with arrest and conviction records pursuant to the San Francisco Fair Chance Ordinance. The Standard offers a drug- and alcohol-free work environment where possession, manufacture, transfer, offer, use of or being impaired by an illegal substance while on The Standard's property, or in other cases which the company believes might affect operations, safety or reputation of the company is prohibited. The Standard requires a criminal background investigation and employment, education and licensing verification as a condition of employment. After any conditional offer of employment is made, the background check will include an individualized assessment based on the applicant's specific record and the duties and requirements of the specific job. Applicants will be provided an opportunity to explain and correct background information. All employees of The Standard must be bondable.