Claims Examiner I or II

WoodmenLife•Omaha, NE

89d•$17 - $25

About The Position

WoodmenLife is hiring a Claims Examiner I or II to secure and analyze claim information and determine whether claims related to life, annuity, and cancer products and benefits should be approved or denied. The position makes claims decisions in accordance with contract terms, documents claim analysis, and meets risk management and regulatory requirements under company policies and practices. Examiners communicate with claimants, beneficiaries, health providers, and other parties to gather information and clarify claim details, and adjudicate and pay claims for life, annuity, and health products. The position may be hybrid or fully remote depending on experience. Claims Examiner I handles administrative duties for life and health claims, including recording new claims, mailing claim paperwork and checks, reviewing claim documentation and beneficiary eligibility, and processing qualifying claims within demonstrated approval limits. The role also verifies information with funeral homes, makes benefit adjustments when applicable, checks state requirements for child-support data matches before payment, and reviews workflows to improve service and meet service-level goals. Claims Examiner II is proficient in all Level I duties and, upon demonstrating required skills and competencies, handles claims within higher independent approval limits. Duties include processing annuity and settlement-option death claims, including variable annuities; determining beneficiary eligibility and distribution options; calculating net gains and tax withholding; preparing beneficiary tax forms; coordinating ownership updates; communicating with families and external professionals and agencies; reviewing and adjudicating certain health claims; and researching claim-disbursement inquiries. WoodmenLife is a purpose-driven, not-for-profit life insurance company that has served members and communities since 1890. It describes its workplace as welcoming to people of all backgrounds and beliefs and is committed to equal opportunity and valuing associates’ perspectives. Candidates must complete applicable background, credit, fingerprint, drug-screen, and reference checks. Applicants needing accommodations should notify Human Resources at the time of application.

Requirements

High school diploma or equivalent education or work experience.
Knowledge of WoodmenLife products and Core Operations systems, policies, and procedures.
Problem-solving ability, including detecting discrepancies, trends, and opportunities for efficiency.
Ability to understand information and communicate it clearly to Home Office associates and external customers.
Ability to provide and receive constructive feedback.
Ability to maintain confidentiality, sensitivity, and professionalism.
Ability to work effectively in a team environment.
Strong concentration and attention to detail.
For Claims Examiner I: knowledge of GLBA and other state and federal regulations.
For Claims Examiner II: proficiency in all Claims Examiner I skills and ability to work with little or no direction from a Senior Examiner or Supervisor.

Nice To Haves

Two or more years of previous claims-processing experience; life and health claims experience is preferred.

Responsibilities

Secure and analyze claim information to determine approval or denial in accordance with contract terms, company policies, and applicable risk-management and regulatory requirements.
Adjudicate and process claims and payments for life, annuity, cancer, and health products.
Compare death notifications with the Client System of Record and take appropriate action.
Enter and code new death and health claims in administrative systems, and mail claim paperwork and checks.
Review applications, claim forms, certified death certificates, and supporting documentation to verify the death and determine whether the claimant is an eligible beneficiary.
Process claims within applicable independent approval limits after demonstrating the required skills and competencies.
Contact funeral homes to verify information for qualifying quick claims.
Determine whether benefit adjustments are needed based on date of death, date of birth, and applicable interest rates.
Review state requirements for beneficiary data matching against Child Support Division databases when processing payments.
Review workflows, recommend process improvements, and help meet service-level goals.
Process annuity and settlement-option death claims, including variable annuities; determine distribution eligibility and options, calculate net gains and tax withholding, prepare tax forms, and coordinate ownership updates.
Communicate with families, sales associates, funeral homes, attorneys, CPAs, law enforcement agencies, health care providers, and facilities to answer questions and obtain information.
Conduct initial review and adjudication of Waiver, Accelerated Benefit Rider, and Continued Proof Health claims.
Research and process inquiries about claim disbursements.