Claims Analyst I - Domestic

Citizens, Inc.•Austin, TX

About The Position

Citizens Inc. is looking for someone who can review proofs of loss quickly, ensure claims are administered in accordance with policy provisions and the company’s practices and philosophy, and work well with others. This requires a detail-oriented mind set, critical thinker who is willing to take initiative and work consultatively with others. This person will work effectively and efficiently to meet expected turnaround times. We look for our claim analysts to be analytical and provide prompt, fair payment of all legitimate claims.

Requirements

Insurance related work experience and strong computer skills acceptable.
Courses in business, finance, economics and mathematics are particularly helpful.
Complete LOMA 1 & 2 (280 & 290) courses, Associate, Customer Service (ACS) designation and working toward the Associate, Life & Health Claims designation (ALHC).
Skill in Microsoft Office products
Excellent analytical, organizational and interpersonal skills
Well-developed written and verbal communication skills
Strong math and/or financial skills

Nice To Haves

Bachelor’s degree preferred.
Associate, Life & Health Claims (ALHC) and Associate, Life Management Institute (ALMI) certifications are necessary for advancement to a claims manager position.

Responsibilities

Answer and respond to inbound telephone inquiries from policy beneficiaries or their representatives and provide excellent service during their claims inquiries.
Correspond with agents, policyholders, hospitals, doctors, attorneys, beneficiaries, and claimants for information regarding the claim.
Correspond with customers for resolutions of concerns through outgoing calls or written communications.
Maintain communication with management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.
Develop and maintain positive working relationships with internal/external stakeholder.
Review policy contracts and determine if coverage is applicable.
Review and prepare claims for processing, update claims information in the claims application.
Determine base payment by referring to policy coverage and limits, deciding on the course of action (payment, further investigation, or denial).
Assess, research, and correct claims discrepancies, collaborating with other team members as needed.
Maintain claims information in the claims application.
Maintain the assigned follow-ups and pending inventory.
Process verifications and manage the verification inventory.
Maintain complete confidentiality of company business.
Participate in educational seminars, webinars, and local claims meetings.
Cross-train on various product processing within the claims department.
Approval limit will vary with experience level, including release authority up to a certain amount.
Ability to establish rapport and build relationships in a professional manner.
Ability to address issues/concerns in a professional manner.
Ability to operate in a fast-paced environment shaped by constant change and innovation.
Ability to balance prompt claim settlement against the need to be accurate in determining liability for each claim.
Comply with HIPAA and other privacy regulations.
Meet the minimum qualitative standards for a Domestic Claims Analyst I (Financial accuracy: 99.5%, Payment accuracy: 98%, Procedural accuracy: 95%).