Claims Examiner Jobs

About The Position

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.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• 401(k)
• Life insurance