Claims Examiner

Описание вакансии

Horace Mann is seeking a detail-oriented and experienced Claims Examiner to join our team in a hybrid work environment in Plano, TX office. This role is responsible for setting up and adjudicating claims efficiently while providing exceptional quality service to build customer satisfaction and loyalty. The ideal candidate will have experience in life/health claims, strong organizational skills, and the ability to communicate effectively with policyholders, healthcare providers, and internal teams. If you thrive in a fast-paced environment, have a keen eye for detail, and enjoy making a meaningful impact, this is the perfect opportunity for you!  This is not a fully remote position, and you must be able to commute to the Plano office.

Responsibilities:

• Link and set up Substantive, Group, Wellness, and Physician Consult claims in the work distribution and policy administration system.
• Evaluate submitted claims by reviewing policy provisions and applicable laws to accurately adjudicate claims.
• Provide claimants with necessary forms, instructions, and assistance to ensure a smooth claims process.
• Draft and send letters requesting medical or other necessary information relevant to claim analysis.
• Ensure timely requests, follow-ups, and closeouts on all submitted claims.
• Maintain claim files in compliance with Fair Claims Settlement PracticeRegulations and company standards.
• Communicate with policyholders, beneficiaries, and healthcare providers regarding claim handling, denials, payments, and policy provisions in a caring, courteous, and professional manner.
• Process payment, denial, or requests for additional information for Wellness, Physician Consult benefits, group, and substantive products.
• Utilize existing knowledge of medical terminology, diseases, conditions, and treatments relevant to company product lines.
• Maintain satisfactory monthly performance rates for processing multiple substantive and group products.
• Perform other duties as assigned.

Requirements:

• 2+ years of experience in life/health claims or a related field.
• High School Diploma or GED required; Bachelor’s degree preferred.
• LOMA or AHIP coursework completed or willingness to enroll.
• Proficiency in Microsoft Outlook, Word, and Excel; ability to type 40+ WPM.
• Strong written/verbal communication, organizational, and analytical skills.
• Ability to interpret policy provisions, prioritize tasks, and manage workload efficiently.
• Maintain a service-oriented and professional environment while collaborating with other departments.

Pay Range:

                $19.66 - $29.04/hr.

Salary is commensurate to experience, location, etc.

Horace Mann was founded in 1945 by two Springfield, Illinois, teachers who saw a need for quality, affordable auto insurance for teachers. Since then, we’ve broadened our mission to helping all educators protect what they have today and prepare for a successful tomorrow.  And with our broadened mission has come corporate growth:  We serve more than 4,100 school districts nationwide, we’re publicly traded on the New York Stock Exchange (symbol: HMN) and we have more than $12 billion in assets.

We’re motivated by the fact that educators take care of our children’s future, and we believe they deserve someone to look after theirs.  We help educators identify their financial goals and develop plans to achieve them.  This includes insurance to protect what they have today and financial products to help them prepare for their future. Our tailored offerings include special rates and benefits for educators.

EOE/Minorities/Females/Veterans/Disabled. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status

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