Claims Examiner

Horace Mann•Plano, TX

15d•Hybrid

About The Position

Horace Mann is seeking a detail-oriented and experienced Claims Examiner to join our team in a hybrid work environment in Plano, TX office. This role is responsible for setting up and adjudicating claims efficiently while providing exceptional quality service to build customer satisfaction and loyalty. The ideal candidate will have experience in life/health claims, strong organizational skills, and the ability to communicate effectively with policyholders, healthcare providers, and internal teams. If you thrive in a fast-paced environment, have a keen eye for detail, and enjoy making a meaningful impact, this is the perfect opportunity for you! This is not a fully remote position, and you must be able to commute to the Plano office.

Requirements

2+ years of experience in life/health claims or a related field.
High School Diploma or GED required; Bachelor’s degree preferred.
LOMA or AHIP coursework completed or willingness to enroll.
Proficiency in Microsoft Outlook, Word, and Excel; ability to type 40+ WPM.
Strong written/verbal communication, organizational, and analytical skills.
Ability to interpret policy provisions, prioritize tasks, and manage workload efficiently.
Maintain a service-oriented and professional environment while collaborating with other departments.

Responsibilities

Link and set up Substantive, Group, Wellness, and Physician Consult claims in the work distribution and policy administration system.
Evaluate submitted claims by reviewing policy provisions and applicable laws to accurately adjudicate claims.
Provide claimants with necessary forms, instructions, and assistance to ensure a smooth claims process.
Draft and send letters requesting medical or other necessary information relevant to claim analysis.
Ensure timely requests, follow-ups, and closeouts on all submitted claims.
Maintain claim files in compliance with Fair Claims Settlement Practice Regulations and company standards.
Communicate with policyholders, beneficiaries, and healthcare providers regarding claim handling, denials, payments, and policy provisions in a caring, courteous, and professional manner.
Process payment, denial, or requests for additional information for Wellness, Physician Consult benefits, group, and substantive products.
Utilize existing knowledge of medical terminology, diseases, conditions, and treatments relevant to company product lines.
Maintain satisfactory monthly performance rates for processing multiple substantive and group products.
Perform other duties as assigned.