Claims Verification Specialist

National Guardian Life Insurance Company•Madison, WI

11d•Hybrid

About The Position

The Claims Verification Specialist is responsible for evaluating claims for accuracy, completeness and adherence to company policies before final distribution of payment, handling escalated claims, providing customer service and assisting with written procedure maintenance. In addition, this position processes a variety of claims and service requests along all lines of business, along with providing phone support. This position effectively communicates and corresponds with external and internal customers including policyholders, agents, funeral directors, beneficiaries, and employers. The Claims Verification Specialist displays excellent teamwork, accountability and desire to share knowledge in a positive team-oriented environment. In this role, work is performed under general supervision.

Requirements

Advanced knowledge of NGL and acquisition products and procedures
Knowledgeable of insurance policy administration systems
Demonstrated ability to interpret insurance policy language
Excellent written and verbal communication skills
Ability to draft professional written communication using correct grammar, punctuation, and spelling
Strong attention to detail with a high level of accuracy
Ability to guide and provide constructive feedback with respect and empathy
Intermediate computer skills with the ability to perform tasks and work in Microsoft Word, Outlook and Excel
Ability to analyze and thorough problem-solving skills
Knowledgeable of basic accounting skills
Ability to work independently and in a team environment
Ability to learn quickly and adeptly handle issues that arise even when unfamiliar
Effective and efficient organizational skills and ability to manage competing demands and tight deadlines
Typing skills of a minimum of 45 words per minute
A minimum of two years of claims processing or other related business experience required.
A minimum of one year of NGL claims processing experience required.

Nice To Haves

Other LOMA Level I Certificate or ACS preferred
A minimum of three years of insurance claims processing experience preferred.

Responsibilities

Evaluate claims for completeness and accuracy ensuring work performed by others is done in accordance with policy, performance metrics and organizational guidelines.
Communicate outcomes with team members, team lead, and supervisor appropriately.
Provide constructive feedback to team members in a collaborative, respectful and positive learning environment.
Verify claims over the audit control threshold based on amount paid and on those that are randomly selected.
Review new hire claims while in training and recommend appropriate audit levels.
Resolve difficulties and escalate issues with suggestions for additional inquiry.
Suggest alternative approaches that meet the needs of the organization, the situation, and those involved.
Resolve escalated cases when presented and be solution-driven in response.
Apply various problem-solving methods and tools to analyze and solve process, procedural, and system issues.
Determine the cause of problems and formulate solutions by testing for justification and plausibility.
Examine several alternative, risk, and benefits of possible resolutions and recommending solutions.
Examine defined issues with ambiguous causes.
Gather and identify needed data and petition input to help recognize the symptoms and root causes of distinct problems.
Utilize knowledge from one process and apply to another like process regarding common situations.
Making sound decisions based on knowledge of procedure and process reasons.
Accurately adjudicate a minimum number of claims per day with high accuracy within defined service timelines.
Verify proper forms are received according to state regulation.
Accurately enter and process a variety of claims ranging in complexity in accordance with written processing procedures and policies.
Accurately calculate cost basis on basic annuity claims.
Accurately review and process contestable claims including referring claim to underwriter as needed.
Follow-up timely on all claims in writing within state regulated timeframes.
Process between queues as determined by business needs.
Authorize minor exceptions (i.e., overnighting or expediting) when needed to ensure exceptional customer service and in compliance with company policy.
Complete recurring audits as required by business partners and compliance requirements including but not limited to Death Master File (DMF) audits, annual surveys such as the MCAS, external audits as requested by third-party companies.
Provide support for escalated claims phone calls and correspondence.
Communicate effectively with empathy to NGL customers verbally, in writing, and via email.
Draft professional written communication, including well-structured emails, using proper grammar, formatting, and tone to convey information to customers.
Actively listen and appropriately respond to others in a professional manner.
Provide phone support for claims-related calls while maintaining team service goals.
Contact agents, funeral homes, beneficiaries, and other customers to obtain missing information when needed.
Prepare proper correspondence for filing of claims, requests for additional information, and follow up.
Communicate with Claims Adjudicators on team processes and update procedures/reference material.
Reinforce processes and procedures with new and existing staff.
Provide timely updates and issues to Team Lead or Manager as needed.
Ensure Standard Operating Procedures are updated, available and disbursed to the team and others affected on agreed upon due dates.
Collaborate with colleagues to help ensure team standards are maintained and collectively work towards shared goals.
Participate in team meetings, training sessions, and group decision-making by listening and responding constructively to others.
Support colleagues by offering assistance and collaboration when needed and in a constructive and professional manner.
Coordinate personal time off, breaks, and lunches with leadership to ensure sufficient team coverage.
Foster a positive, inclusive, and cooperative team environment.
Represent Claims Team on various projects/committees.
Complete assigned projects, tasks, and/or milestones by agreed upon due dates.
Perform other related duties as requested.

Benefits

20 days of Paid Time Off growing to 25 days after 5 years
11 Paid Holidays (10 company holidays and 1 personal holiday of your choice)
Health care, dental and vision plans
Up to $1,500 (Family) or $1,000 (Single) annually towards a Health Savings Account
Annual bonus based on company performance
Paid Parental Leave
401(k) match up to 9%
Paid Sabbatical after 8 years
Paid Volunteer Time
Education Assistance Program
Employee Recognition Program