WoodmenLife
Overview
Join to apply for the
Sr Claims Examiner
role at
WoodmenLife . WoodmenLife is looking for a Sr Claims Examiner to join our team. This remote position involves securing and analyzing claim information to determine the approval or denial of claims related to Life, Annuity and Cancer products and benefits. The Sr Claims Examiner makes informed claims decisions in accordance with the terms of the contract, performs detailed analysis and documentation of claim data to direct effective outcomes, and meets risk management and regulatory requirements in accordance with WoodmenLife’s policies and practices. The Sr Claims Examiner communicates with claimants, beneficiaries, health providers or others to gather information and clarify details of the claims. The role includes adjudication and payment of all types of claims for life, annuity and health products. This is a remote position. WoodmenLife is a not-for-profit life insurance company with over 130 years of service. As a member of the WoodmenLife family, you’re joining others who share your commitment to family, community and country. Through WoodmenLife, you’ll have opportunities to give back locally and honor those who make an impact. As a not-for-profit organization, we’ve been helping to protect the financial future of families since 1890. We offer a variety of benefits including health, dental, vision, 401K, life insurance and more. Apply today to learn more!
Responsibilities
Serves as back up to Complex Claim Examiner, including:
Processes accidental death claims, researches additional reports or documentation, and determines benefits entitled under the Accidental Death Benefit Rider.
Processes Suicide Claims, researches additional reports or documentation, and ensures the certificate falls within the Suicide Exclusion Period.
Processes Homicide Claims (investigates if the beneficiary was involved in the death).
Rival Claimants — Identifies and corresponds on claims when more than one person claims the same proceeds; consults with the Legal Department as needed and follows WoodmenLife guidelines; communicates with all parties until resolved; coordinates with Legal through the interpleader process until the proceeds are paid.
Audits and authorizes payment of claims worked by other examiners within Levels I–II.
Independent claim approval limits up to $500,000 upon demonstrated skills and competencies.
Reviews contestable claims for accuracy; assists associates or sales representatives with difficult calls or claims situations, providing instruction and guidance.
Assists with internal and external audits (e.g., E&Y or state audits).
Qualifications
High school diploma or equivalent.
Knowledge of WoodmenLife products and Core Operations systems, policies and procedures.
Strong problem-solving abilities to detect discrepancies, trends and efficiencies.
Ability to communicate clearly with Home Office associates and external customers.
Ability to provide and receive constructive feedback; maintain confidentiality and professionalism.
Ability to work well in a team and with a high level of concentration and attention to detail.
Prefer 5+ years of experience in life and health claims processing.
Ability to use multiple resources to research and resolve customer claims and interactions with State Insurance Departments.
Benefits and notice WoodmenLife offers a competitive compensation package and comprehensive benefits. More information: https://www.woodmenlife.org/careers/home-office/benefits/
As part of WoodmenLife’s employment process, candidates will undergo background checks, credit checks where required, fingerprint checks where required, drug screening, and reference checks. Offers contingent on passing these checks.
Equal Opportunity WoodmenLife is an equal opportunity employer. We welcome applicants regardless of background and beliefs and are committed to an environment that values differences and provides opportunities for growth, leadership and service.
APPLICANTS WITH DISABILITIES SHOULD ADVISE THE HUMAN RESOURCES DEPARTMENT AT THE TIME OF APPLICATION IF SPECIAL ACCOMMODATIONS ARE NEEDED.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries
Insurance
#J-18808-Ljbffr
Join to apply for the
Sr Claims Examiner
role at
WoodmenLife . WoodmenLife is looking for a Sr Claims Examiner to join our team. This remote position involves securing and analyzing claim information to determine the approval or denial of claims related to Life, Annuity and Cancer products and benefits. The Sr Claims Examiner makes informed claims decisions in accordance with the terms of the contract, performs detailed analysis and documentation of claim data to direct effective outcomes, and meets risk management and regulatory requirements in accordance with WoodmenLife’s policies and practices. The Sr Claims Examiner communicates with claimants, beneficiaries, health providers or others to gather information and clarify details of the claims. The role includes adjudication and payment of all types of claims for life, annuity and health products. This is a remote position. WoodmenLife is a not-for-profit life insurance company with over 130 years of service. As a member of the WoodmenLife family, you’re joining others who share your commitment to family, community and country. Through WoodmenLife, you’ll have opportunities to give back locally and honor those who make an impact. As a not-for-profit organization, we’ve been helping to protect the financial future of families since 1890. We offer a variety of benefits including health, dental, vision, 401K, life insurance and more. Apply today to learn more!
Responsibilities
Serves as back up to Complex Claim Examiner, including:
Processes accidental death claims, researches additional reports or documentation, and determines benefits entitled under the Accidental Death Benefit Rider.
Processes Suicide Claims, researches additional reports or documentation, and ensures the certificate falls within the Suicide Exclusion Period.
Processes Homicide Claims (investigates if the beneficiary was involved in the death).
Rival Claimants — Identifies and corresponds on claims when more than one person claims the same proceeds; consults with the Legal Department as needed and follows WoodmenLife guidelines; communicates with all parties until resolved; coordinates with Legal through the interpleader process until the proceeds are paid.
Audits and authorizes payment of claims worked by other examiners within Levels I–II.
Independent claim approval limits up to $500,000 upon demonstrated skills and competencies.
Reviews contestable claims for accuracy; assists associates or sales representatives with difficult calls or claims situations, providing instruction and guidance.
Assists with internal and external audits (e.g., E&Y or state audits).
Qualifications
High school diploma or equivalent.
Knowledge of WoodmenLife products and Core Operations systems, policies and procedures.
Strong problem-solving abilities to detect discrepancies, trends and efficiencies.
Ability to communicate clearly with Home Office associates and external customers.
Ability to provide and receive constructive feedback; maintain confidentiality and professionalism.
Ability to work well in a team and with a high level of concentration and attention to detail.
Prefer 5+ years of experience in life and health claims processing.
Ability to use multiple resources to research and resolve customer claims and interactions with State Insurance Departments.
Benefits and notice WoodmenLife offers a competitive compensation package and comprehensive benefits. More information: https://www.woodmenlife.org/careers/home-office/benefits/
As part of WoodmenLife’s employment process, candidates will undergo background checks, credit checks where required, fingerprint checks where required, drug screening, and reference checks. Offers contingent on passing these checks.
Equal Opportunity WoodmenLife is an equal opportunity employer. We welcome applicants regardless of background and beliefs and are committed to an environment that values differences and provides opportunities for growth, leadership and service.
APPLICANTS WITH DISABILITIES SHOULD ADVISE THE HUMAN RESOURCES DEPARTMENT AT THE TIME OF APPLICATION IF SPECIAL ACCOMMODATIONS ARE NEEDED.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries
Insurance
#J-18808-Ljbffr