Claims Examiner I or II

Claims Examiner I Or II

WoodmenLife is looking to hire Claims Examiner I or II to join our team. In this role, you will be responsible for securing and analyzing claim information to determine the approval or denial of claims related to Life, Annuity and Cancer products and benefits. The role involves making informed claims decisions in accordance with the terms of the contract, performing detailed analysis and documentation of claim data to direct effective outcomes, and meeting risk management and regulatory requirements in accordance with WoodmenLifes policies and practices. The claim examiner communicates with claimants, beneficiaries, health providers or others to gather information and clarify details of the claims. The claims examiners are responsible for the adjudication and payment of all types claims for life, annuity and health products.

Claims Examiner I Non-Exempt:

• Handles all the administrative duties for Life and Health Claims
• Compare and analyze death notification against Client System of Record and takes appropriate action
• Enters and codes all new deaths or health claims into administrative systems
• Mails claim paperwork and checks
• Examines death or health claims on life and annuity insurance certificates and cancer product
• Reviews applications and claim forms, certified death certificate and any additional documentation to assure that a valid death has occurred, and correct beneficiary has made claim for the proceeds
• Reviews the beneficiary designated and determines if the beneficiary is eligible for payment
• Upon demonstration of required skills and competencies: Life -independent approval limits up to $75,000 Cancer-independent approval limits up to $25,000
• Makes calls to Funeral Homes verifying needed information in order to process claims with face amounts that qualify as quick claims
• Determines if adjustments are needed to the benefit amounts WoodmenLife is liable for based on the date of death, date of birth, and applicable interest rates
• At time of payment, reviews state requirements to determine if WoodmenLife is required to perform a data match of its beneficiaries against a Child Support Division database in an attempt to intercept payments to a parent who may be in default of their child support obligations
• Continually reviews and analyzes the workflow to provide efficient service and meet service level goals
• Makes recommendations for changes that enhance the process and improve customer service

Claims Examiner II Non-Exempt: (Proficient in all of Level I and 75% of Level II)

• Proficient in all Level I duties
• Upon demonstration of required skills and competencies: Life & Annuity-independent approval limits up to $300,000 Cancer-independent approval limits up to $60,000
• Processes annuity and settlement options death claims, including Variable Annuities
• Identify the type of annuity to be paid
• Determines if the beneficiary is eligible to receive the elected distribution option under WoodmenLife policies and procedures and IRS regulations
• After confirmation of elected distribution method, completes claim processing calculates the net gain, determines federal/state withholding, creates tax forms for each beneficiary, and coordinates with other departments to ensure ownership changes are updated accordingly
• Communicates with families, sales associates, funeral homes, attorneys, CPAs, law enforcement agencies, health care providers or facilities, etc. to answer a wide variety of questions
• Initial review and Adjudication of Waiver, Accelerated Benefit Rider and Continued Proof Health Claims
• Researches and processes any inquiries on claim disbursements as needed

We need someone who has:

• High school diploma or equivalent education/work experience
• Demonstrates knowledge of WoodmenLife products and knowledge of Core Operations systems, policies and procedures
• Demonstrates in-depth problem-solving capabilities, including ability to detect discrepancies, trends and efficiencies needed
• Ability to understand and then clearly communicate information and answers to Home Office associates and external customers
• Ability to provide and receive constructive feedback
• Ability to maintain confidentiality, sensitivity and professionalism
• Ability to work well with others in a team environment
• Ability to work with a high level of concentration and attention to detail

Claims Examiner I Knowledge of GLBA along with other state and federal regulations. Claims Examiner II Proficient in all Level I skills. The ability to work with little or no direction from Senior Examiner or Supervisor. Prefer 2+ years previous experience in claims processing life and health preferred.

If you're ready to make an impact in your community, wed love to hear from you. Apply today! As part of WoodmenLifes employment process, candidates will be required to complete a criminal background check, credit check (when required for position), fingerprint check (when required for position), drug screen and reference checks. Any offer of employment will be contingent upon successfully passing the above. WoodmenLife is welcoming to all regardless of background and beliefs. WoodmenLife respects every associates unique perspective and contribution. We are committed to creating an environment that values differences, and creates opportunities for growth, leadership and service. This commitment includes providing equal opportunity in recruitment, employment and promotion, training and community outreach. WoodmenLife is also dedicated to strengthening the communities in which its employees live.