Life & DI Claims Examiner I

Renaissance Life & Health Insurance Company of America•Indianapolis, IN

1d•Hybrid

About The Position

Renaissance Benefits is seeking a Life and Disability Claims Examiner to evaluate and process group insurance claims for payment or denial in accordance with policy terms and conditions. The role reviews claims for compliance with guidelines and eligibility requirements, gathers missing information, investigates claims, determines benefits, and makes timely claim determinations, payments, approvals, and adjustments. Complex claims may be referred to a manager or discussed with senior team members and other professionals. The examiner communicates with claimants, employers, policyholders, beneficiaries, and other parties about claim status, documentation, time frames, payment information, return-to-work expectations, and next steps. Communication may take place by phone, written correspondence, or claims systems. The position also handles customer-service calls and written inquiries from insureds, group policyholders, agents, medical providers, attorneys, government agencies, other insurers, and internal staff, while meeting established service and quality standards. The position is hybrid for candidates local to the Indianapolis, Indiana area. Compensation is $25.00–$26.00 per hour. Renaissance Benefits provides equal employment and advancement opportunity without regard to protected characteristics or statuses listed in the job posting.

Requirements

Associate degree in Business preferred.
2–4 years of related industry experience preferred.
Disability and/or life insurance claims administration experience strongly preferred.
Knowledge of ERISA regulations, statutory disability claims administration, required offsets and deductions, disability duration and medical management practices, and Social Security application procedures strongly preferred.
Basic proficiency in Microsoft Word/Microsoft Office Suite required.
Intermediate proficiency in Microsoft Excel required.
Experience with claims management systems and electronic or paperless claims processing strongly preferred.
Ability to perform work accurately and thoroughly.
Ability to pay close attention to detail.
Ability to prioritize and organize a heavy workload.

Nice To Haves

Associate degree in Business.
2–4 years of related industry experience.
Disability and/or life insurance claims administration experience.
Knowledge of ERISA regulations, statutory disability claims administration, required offsets and deductions, disability duration and medical management practices, and Social Security application procedures.
Experience with claims management systems and electronic or paperless claims processing.

Responsibilities

Evaluate and process group insurance claims for payment or denial according to policy terms and conditions.
Review submitted claims to confirm guidelines were followed and eligibility requirements were met.
Contact policyholders, beneficiaries, and other third parties to obtain missing information.
Consult management, senior team members, and other resources regarding complex claims.
Communicate with claimants and employers about return-to-work expectations, claim status, and next steps.
Explain required documentation, time frames, payment information, and claim status by phone, written correspondence, or claims system.
Determine benefits due and make timely claim determinations, payments, approvals, and adjustments.
Investigate claims by searching databases, interviewing claimants and witnesses, and consulting police records, hospital records, and policy files.
Calculate and authorize appropriate claim payments or refer claims to a manager for additional review.
Assist with claims involving suspected fraudulent or criminal activity, including reviewing personal information and past claim histories for possible insurance fraud.
Answer verbal and written inquiries and customer-service queued calls about group claims from insureds, policyholders, agents, medical providers, attorneys, government agencies, other insurance carriers, third-party administrators, reinsurers, and internal staff.
Respond to information requests and return calls within established service guidelines.
Adhere to quality standards for calls and written inquiries.
Perform other duties and responsibilities as needed or assigned.