Supplemental Claims Examiner

Introduction

Were motivated by the fact that educators take care of our childrens 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.

Overview

Horace Mann is seeking a detail-oriented and experiencedClaims Examiner to join our team in ahybrid work environment in Addison, TX. This role is responsible for setting up and adjudicating claims efficiently while providingexceptional quality service to build customer satisfaction and loyalty. The ideal candidate will have experience inlife/health claims , strong organizational skills, and the ability to communicate effectively with policyholders, healthcare providers, and internal teams. If you thrive in afast-paced environment , have akeen 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 Addison 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 inlife/health claims or a related field.
• High School Diploma or GED required ;Bachelors degree preferred .
• LOMA or AHIP coursework completed or willingness to enroll.
• Proficiency in Microsoft Outlook, Word, and Excel ; ability totype 40+ WPM .
• Strongwritten/verbal communication, organizational, and analytical skills .
• Ability tointerpret policy provisions, prioritize tasks, and manage workload efficiently .
• Maintain aservice-oriented and professional environment while collaborating with other departments.

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