Claims Analyst I - Domestic

Citizens, Inc.•Donaldsonville, LA

About The Position

Citizens Inc. is seeking a detail-oriented, analytical Claims Analyst I to review proofs of loss, administer claims in accordance with policy provisions and company practices, and help ensure prompt and fair payment of legitimate claims. The role requires sound judgment, initiative, effective collaboration, and the ability to meet expected turnaround times while balancing prompt settlement with accurate liability determinations. The analyst serves beneficiaries and their representatives by responding to telephone inquiries and communicating with agents, policyholders, hospitals, doctors, attorneys, beneficiaries, and claimants. The position reviews policy contracts and claims, determines whether coverage applies, prepares claims for processing, updates claim records, assesses discrepancies, and determines whether to pay, investigate further, or deny a claim. It also includes maintaining follow-up and verification inventories, protecting confidential information, participating in learning activities, and cross-training on products within the claims department. Release authority varies with experience: an analyst may be approved to release claims up to $1,000 without secondary review and may have authority to release claims up to $10,000. Performance standards include financial accuracy of 99.5%, payment accuracy of 98%, and procedural accuracy of 95%, as well as compliance with HIPAA and other privacy regulations. A bachelor’s degree is preferred, though insurance-related work experience and strong computer skills are acceptable. The role calls for analytical, organizational, interpersonal, communication, and math or financial skills. Employees receive a benefits package that includes medical, dental, vision, disability, life insurance, a matching 401(k), virtual visits, an Employee Assistance Program, paid time off, and holidays.

Requirements

Bachelor’s degree preferred; insurance-related work experience and strong computer skills are acceptable alternatives.
Complete LOMA 1 and 2 (280 and 290) courses and the Associate, Customer Service (ACS) designation, and work toward the Associate, Life & Health Claims (ALHC) designation.
Skill in Microsoft Office products.
Excellent analytical, organizational, and interpersonal skills.
Well-developed written and verbal communication skills.
Strong math and/or financial skills.
Ability to establish rapport and build professional relationships.
Ability to address issues and concerns professionally.
Ability to work in a fast-paced environment shaped by change and innovation.
Ability to balance prompt claim settlement with accurate liability determinations.
Ability to meet expected turnaround times and maintain stated claims accuracy standards.

Nice To Haves

Courses in business, finance, economics, or mathematics are particularly helpful.
Associate, Life & Health Claims (ALHC) and Associate, Life Management Institute (ALMI) certifications are necessary for advancement to a claims manager position.

Responsibilities

Respond to inbound telephone inquiries from policy beneficiaries or their representatives and provide service during claims inquiries.
Communicate with agents, policyholders, hospitals, doctors, attorneys, beneficiaries, and claimants to obtain claim information.
Resolve customer concerns through outgoing calls or written communications.
Keep management informed about developments in assigned areas and complete special projects as requested.
Develop and maintain positive working relationships with internal and external stakeholders.
Review policy contracts and determine whether coverage applies.
Review and prepare claims for processing and update claim information in the claims application.
Determine base payment based on policy coverage and limits, and decide whether to pay, investigate further, or deny a claim.
Assess, research, and correct claims discrepancies, collaborating with team members as needed.
Maintain claims information in the claims application.
Maintain assigned follow-ups and pending inventory.
Process verifications and manage verification inventory.
Maintain confidentiality of company business.
Participate in educational seminars, webinars, and local claims meetings.
Cross-train on processing various products within the claims department.
Meet the stated qualitative standards for financial, payment, and procedural accuracy.
Comply with HIPAA and other privacy regulations.