Claims Examiner I or II

WoodmenLIfe•Omaha, NE

19d•Hybrid

About The Position

This position could be hybrid or possibly fully remote depending on level of experience. WoodmenLife is looking to hire Claims Examiner I or II to join our team! In this role, you will be responsible for securing and analyzing claim information to determine the approval or denial of claims related to Life, Annuity and Cancer products and benefits. The role involves making informed claims decisions in accordance with the terms of the contract, performing detailed analysis and documentation of claim data to direct effective outcomes, and meeting risk management and regulatory requirements in accordance with WoodmenLife’s policies and practices. The claim examiner communicates with claimants, beneficiaries, health providers or others to gather information and clarify details of the claims. The claims examiners are responsible for the adjudication and payment of all types claims for life, annuity and health products. WoodmenLife is one of the best places to work in Omaha, with more than 135 years of service rooted in purpose and community. Since 1890, WoodmenLife has been dedicated to helping hardworking Americans secure their families’ financial futures and leave a lasting legacy. As a purpose‑driven, not‑for-profit life insurance company, our commitment is to our members and the communities they call home. As a member of the WoodmenLife family, you’ll join others who share a commitment to family, community, and country. We offer a comprehensive benefits package including health, dental, vision, 401(k), life insurance, and more. Apply today to learn more! What we are looking for: Claims Examiner I – Non-Exempt Handles all the administrative duties for Life and Health Claims that includes but not limited to: Compare and analyze death notification against Client System of Record and takes appropriate action. Enters and codes all new deaths or health claims into administrative systems Mails claim paperwork and checks Examines death or health claims on life and annuity insurance certificates and cancer product. Reviews applications and claim forms, certified death certificate and any additional documentation to assure that a valid death has occurred, and correct beneficiary has made claim for the proceeds. Reviews the beneficiary designated and determines if the beneficiary is eligible for payment. Upon demonstration of required skills and competencies: Life -independent approval limits up to $75,000 Cancer-independent approval limits up to $25,000 Makes calls to Funeral Homes verifying needed information in order to process claims with face amounts that qualify as “quick” claims. Determines if adjustments are needed to the benefit amounts WoodmenLife is liable for based on the date of death, date of birth, and applicable interest rates, At time of payment, reviews state requirements to determine if WoodmenLife is required to perform a data match of its beneficiaries against a Child Support Division database in an attempt to intercept payments to a parent who may be in default of their child support obligations. Continually reviews and analyzes the workflow to provide efficient service and meet service level goals. Makes recommendations for changes that enhance the process and improve customer service. Claims Examiner II – Non-Exempt: (Proficient in all of Level 1 and 75% of Level II) Proficient in all Level I duties. Upon demonstration of required skills and competencies: Life & Annuity-independent approval limits up to $300,000 Cancer-independent approval limits up to $60,000 Processes annuity and settlement options death claims, including Variable Annuities. Identify the type of annuity to be paid. Determines if the beneficiary is eligible to receive the elected distribution option under WoodmenLife policies and procedures and IRS regulations. After confirmation of elected distribution method, completes claim processing calculates the net gain, determines federal/state withholding, creates tax forms for each beneficiary, and coordinates with other departments to ensure ownership changes are updated accordingly. Communicates with families, sales associates, funeral homes, attorneys, CPA’s, law enforcement agencies, heath care providers or facilities, etc. to answer a wide variety of questions. Initial review and Adjudication of Waiver, Accelerated Benefit Rider and Continued Proof Health Claims Researches and processes any inquiries on claim disbursements as needed.

Requirements

High school diploma or equivalent education/work experience.
Demonstrates knowledge of WoodmenLife products and knowledge of Core Operations systems, policies and procedures.
Demonstrates in-depth problem-solving capabilities, including ability to detect discrepancies, trends and efficiencies needed.
Ability to understand and then clearly communicate information and answers to Home Office associates and external customers.
Ability to provide and receive constructive feedback.
Ability to maintain confidentiality, sensitivity and professionalism.
Ability to work well with others in a team environment.
Ability to work with a high level of concentration and attention to detail.
Knowledge of GLBA along with other state and federal regulations.
Proficient in all Level I skills.
The ability to work with little or no direction from Senior Examiner or Supervisor.

Nice To Haves

2+ years previous experience in claims processing life and health preferred.

Responsibilities

Securing and analyzing claim information to determine the approval or denial of claims related to Life, Annuity and Cancer products and benefits.
Making informed claims decisions in accordance with the terms of the contract
Performing detailed analysis and documentation of claim data to direct effective outcomes
Meeting risk management and regulatory requirements in accordance with WoodmenLife’s policies and practices
Communicating with claimants, beneficiaries, health providers or others to gather information and clarify details of the claims.
Adjudication and payment of all types claims for life, annuity and health products.
Compare and analyze death notification against Client System of Record and takes appropriate action.
Enters and codes all new deaths or health claims into administrative systems
Mails claim paperwork and checks
Examines death or health claims on life and annuity insurance certificates and cancer product.
Reviews applications and claim forms, certified death certificate and any additional documentation to assure that a valid death has occurred, and correct beneficiary has made claim for the proceeds.
Reviews the beneficiary designated and determines if the beneficiary is eligible for payment.
Makes calls to Funeral Homes verifying needed information in order to process claims with face amounts that qualify as “quick” claims.
Determines if adjustments are needed to the benefit amounts WoodmenLife is liable for based on the date of death, date of birth, and applicable interest rates,
Reviews state requirements to determine if WoodmenLife is required to perform a data match of its beneficiaries against a Child Support Division database in an attempt to intercept payments to a parent who may be in default of their child support obligations.
Continually reviews and analyzes the workflow to provide efficient service and meet service level goals.
Makes recommendations for changes that enhance the process and improve customer service.
Processes annuity and settlement options death claims, including Variable Annuities.
Identify the type of annuity to be paid.
Determines if the beneficiary is eligible to receive the elected distribution option under WoodmenLife policies and procedures and IRS regulations.
After confirmation of elected distribution method, completes claim processing calculates the net gain, determines federal/state withholding, creates tax forms for each beneficiary, and coordinates with other departments to ensure ownership changes are updated accordingly.
Communicates with families, sales associates, funeral homes, attorneys, CPA’s, law enforcement agencies, heath care providers or facilities, etc. to answer a wide variety of questions.
Initial review and Adjudication of Waiver, Accelerated Benefit Rider and Continued Proof Health Claims
Researches and processes any inquiries on claim disbursements as needed.