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Group Claims Examiner
Location
United States
Posted
25 days ago
Salary
$27 - $38 / hour
Seniority
Mid Level
Job Description
Group Claims Examiner
Horace Mann
• Review and manage Life, Disability, and Waiver of Premium claims, ensuring compliance with company policies and regulatory standards. • Evaluate waiting periods, verify medical providers and treatment institutions, and assess the reasonableness of fees. • Determine claim applicability, conduct investigations, and evaluate allowable benefits under policies or certificates. • Approve claims within assigned authority limits, escalating complex or high value claims as necessary. • Accurately enter and maintain claims data within the claims management system. • Gather and verify documentation to ensure timely and accurate claim processing. • Conduct detailed reviews to validate claim accuracy and identify discrepancies or potentially fraudulent activity. • Provide prompt, courteous, and professional service to clients, employers, broker partners, and internal stakeholders. • Communicate effectively with claimants and beneficiaries to resolve inquiries and ensure clarity throughout the claims process. • Maintain organized, audit-ready claim files that support transparency and compliance. • Partner with legal, compliance, underwriting, and SIU teams on complex, disputed, or potentially fraudulent claims. • Ensure adherence to all regulatory requirements, company policies, and service standards. • Support a consistent and compliant claims handling approach across all lines of business. • Analyze claims data to identify trends, patterns, and opportunities for improvement. • Prepare reports and summaries for leadership to support data-driven decision-making. • Partner with internal teams to improve workflows, reduce cycle times, and enhance claim outcomes. • Support implementation of new tools, systems, and best practices to improve efficiency and customer satisfaction. • Stay current on industry regulations, product updates, and compliance requirements.
Job Requirements
- High School Diploma or GED required
- Bachelor’s degree in a related field or equivalent experience preferred
- 2–4 years of experience in group insurance claims processing or related financial services role
- Strong understanding of insurance policies, claims practices, and regulatory standards
- Proficiency with claims management systems and Microsoft Office applications
- Excellent analytical, problem-solving, and decision-making skills
- Strong attention to detail and ability to manage multiple priorities in a fast-paced environment
- Effective written and verbal communication skills
- Commitment to continuous learning and professional development.
Benefits
- Normal office environment
- Periodic travel may be required
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