Claims Associate

Position Summary:

The Claims Associate plays a pivotal role by ensuring the swift processing and assessment of claims. This position involves evaluating and facilitating the resolution of claims while maintaining adherence to company policies and industry regulations. The claims associate will collaborate with internal departments, communicate effectively with policyholders and ensure detailed documentation of claims activities are maintained.

Summary of Essential Functions:

• Accurately assess and process claims, including death claims, internal and external transfers, checks, and Medicaid requests, in accordance with company policies and industry regulations.
• Validate correctness of correspondence, forms and all communications to employees, agents, and members.
• Investigate and gather necessary information to evaluate the validity of claims, including communication with policyholders and/or relevant stakeholders.
• Collaborate with internal departments, such as underwriting and risk management, to ensure a comprehensive understanding of policy terms and conditions.
• Analyze documentation to determine coverage eligibility and settlement amounts.
• Maintain detailed records of claim activities, ensuring proper documentation for future reference and regulatory compliance.
• Communicate claim decisions professionally and effectively to policyholders, providing clear explanations and addressing any inquiries.
• May assist in the development and implementation of claims processing improvements to enhance efficiency and customer satisfaction.
• Collaborate with legal when necessary, escalating claims with potential legal implications and providing support as needed.
• Stay informed about industry trends, legal developments, and changes in regulations to ensure compliance and best practices.
• Participate in training programs to enhance knowledge of insurance products, claims processing systems, and customer service skills.

Other duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Requirements:

• Associate degree in business, finance, or related field required; Bachelor’s Degree a plus.
• Two Years experience working with Life and Annuity claims preferred.
• Strong organizational skills with an ability to manage multiple tasks simultaneously.
• Excellent verbal and written communication skills
• Proficient in Microsoft Office Suite
• Ability to work independently and as part of a team, demonstrating flexibility and adaptability.
• Familiarity with insurance policies, regulations, and industry standards is required.

Important: We are an Equal Opportunity Employer and Drug Free Workplace

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work setting:

• In-person
• Office

Application Question(s):

• What are your salary expectations?

Education:

• Associate (Required)

Experience:

• Life and Annuity Claims: 2 years (Preferred)

Work Location: In person