Life & DI Claims Examiner I

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

2d•$25 - $26•Hybrid

About The Position

Renaissance Benefits is seeking an experienced Life and Disability Claims Examiner to join its growing team. The Life & DI Claims Examiner I evaluates and processes group insurance claims for payment or denial according to each policy’s terms and conditions. Candidates local to the Indianapolis area will work on a hybrid schedule.

Requirements

Basic proficiency in Microsoft Word and the Office Suite.
Intermediate proficiency in Microsoft Excel.
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 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.
Experience with claims management systems and electronic or paperless claims processing strongly preferred.

Responsibilities

Review submitted claims to ensure guidelines have been followed and eligibility requirements have been met; contact policyholders, beneficiaries, or third parties for missing information.
Consult management, senior team members, and other resources on complex claims.
Communicate with claimants and employers about return-to-work expectations, claim status, and next steps, by phone or in writing.
Inform claimants of required documentation and time frames, payment information, and claim status by phone, 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 and hospital records and policy files to verify reported information.
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 professionals, attorneys, agencies, carriers, reinsurers, third-party administrators, and internal staff.
Respond to information requests and return calls within established service guidelines.
Meet quality standards for handling calls and written inquiries.
Perform other duties and responsibilities as needed or assigned.