Life & Disability Claims Examiner

Job Title: Life & Disability Claims Examiner

Location: Lombard, IL; Richardson, TX; Amarillo, TX (Hybrid)

Duration & Type: Initial 6-Month Contract with potential for extension

Compensation: Competitive hourly rate, Access to Healthcare, Dental, and Vision Insurance Plan of Choice, and 401K

Chamberlain Advisors is currently seeking a Life & Disability Claims Examiner for our direct client in the highly competitive insurance and financial products industry. This is an initial 6-month contract with likely extensions up to 2 years. The ideal candidate will effectively manage and resolve various insurance claims through thorough investigation, clear communication, and accurate documentation, ensuring compliance with company policies and regulations. Click apply now and join the Chamberlain experience.

Summary

Under supervision, this position is responsible for examining and processing all claim types including short term or long term disability, life, waiver of premium, critical illness, accident insurance and other claim type for various policies. May perform a variety of related duties or travel to client sites to discuss / resolve claim issues.

Ideal Candidate Profile

• The ability to communicate effectively and professionally in both verbal and written forms is crucial for handling inquiries and resolving issues with insureds, beneficiaries, policyholders, and internal stakeholders.
• The ability to investigate, research, verify, and obtain necessary information to determine eligibility and interpret information is essential for resolving claims accurately and efficiently.
• Providing professional, prompt, and accurate customer service via telephone and in writing, while handling various claim types, is a key responsibility of the role.
• The ability to handle multiple tasks, prioritize work effectively, and maintain accurate documentation of activities in claim files is necessary to stay within the department’s established turnaround schedule.
• Proficiency in using PC software including Word, Excel, PowerPoint, Outlook, and specific claim processing systems like ECM, STAR, Genelco/GIAS, Siebel, UTS, Casetrak, Docsql, Benefits Manager, and ImagePlus is required for performing daily tasks efficiently.
  
  

What You Will Be Accountable For

• Assume responsibility for all assigned large accounts and sensitive groups to review and resolve customer problems and complaints concerning claims matters and personally handles the claim through resolution.
• Proactively communicate and respond to claim inquiries from insureds, beneficiaries, policyholders and internal stakeholders; resolve issues through effective verbal and written communication by involving appropriate people within, or outside the department or company; effectively and professionally represent the company in all interactions.
• Relieve and complete work assignments for other Claim Representatives during absences, etc. to stay within the Department's established turnaround schedule.
• Investigate, research, verify and diligently obtains medical information on all claim types to determine eligibility and interpret information relating to the severity of the stated disability or incident.
• Adjudicate claims in accordance with established policies and procedures.
• Interview, make calls and/or corresponds with customers to determine extent of customer concern and resolves situation in accordance with standard operating procedures.
• Proactively identify inconsistencies or lag in claim information and utilize effective approaches and resources to obtain clarification or verification.
• Obtain complete and accurate information from groups, agencies, physicians, claimants, etc., to verify and ensure claim eligibility and/or continued disability.
• Maintain accurate documentation of activities in claim file in accordance with company practices and procedures.
• Maintain thorough knowledge of all policies, statutes and regulations, medical conditions and departmental procedures to ensure proper dispositions of claims.
• Recommend changes to management to avoid recurring customer inquiries/problems.
• Adhere to quality, production, service and departmental guidelines to process claims.
• Provide professional, prompt and accurate customer service via telephone and in writing to members, groups, doctors, etc., in handling various claim types.
• Approve or deny claims within policy limits; recommend approval, denial, rescission or settlement of disputed claims.
• Communicate with outside attorneys, group representatives, claimants, reinsurers, and the State Board of Insurance to exchange information and respond verbally or in writing to inquiries.
• Assist in the preparation of grievance summaries and information for lawsuits.
• Coordinate, with various reinsurance companies, the gathering of information and submission of claims under the reinsurance treaties.
• Research cases of concern to the State Insurance Department; compiles data and composes response letter for approval by Manager.
• Examine and analyze life claim information and makes benefit decisions and payments on claims up to $75,000 aggregate liability.
  
  

Additional Responsibilities Required by All Employees:

• Act with integrity and maintain a respectful, professional manner in all interactions with co-workers, management, customers and other business contacts.
• Comply with HIPAA, the Code of Business Ethics & Conduct, our Diversity & Inclusion Principles, and other applicable corporate and departmental policies.
• Maintain complete confidentiality in all matters of company business.
• Maintain communication with management regarding developments within areas of assigned responsibilities, and perform special projects as required or requested.
  
  

What Qualifications You Need

• Bachelor degree or 4 years of business experience.
• 2 years of claims experience.
• Problem solving and research skills.
• PC proficiency to include Word, Excel, PowerPoint, Outlook and Lotus Notes.
• Customer Service experience.
• Organizational skills.
• Experience handling multiple tasks and making priorities.
• Clear and concise verbal and written communication skills.
• Experience with reviewing medical documentation and medical records.
• Experience with paying, and writing comprehensive denial letters for Accidental, Critical Illness and Hospital Indemnity claims.
• Proficient in the following: Correspondence, Medical Records Review, Misrepresentation Investigation, Pre-Existing Investigation, Evidence of Insurability Review, Benefit Entitlement Review, Financial Accuracy, ERISA Guidelines, MAR Requirements, State Regulations, Contract Language, Company Financial Liability.
• Experience in the following core systems: ECM, STAR (Claim System), Genelco/GIAS, Siebel, UTS, Casetrak, Docsql, Benefits Manager, and ImagePlus.
• Experience processing one (1) of the following claim types: Life or Waiver of Premium claims.
• Experience in processing any of the following two (2) claim types: Critical Illness/Specified Disease, Accidental Insurance, GAP, Permanent and Total Disability (PTD benefits, Accidental Death and Dismemberment, Permanent and Total Disability (PTD), Accelerated Death Benefits.
  
  

Preferred Job Qualifications:

• LOMA courses.
• Aptitude for math and critical thinking skills.
• Knowledge of state regulations, statutes, and ERISA.
  
  

About the Client

Our client offers a broad selection of highly competitive insurance and financial products covering diverse markets including Employer Paid and Voluntary Group Benefits and an array of Enhanced Product Services. They are a subsidiary of the largest non-investor-owned health insurer in the United States and the fourth overall. Great, friendly team and work environment.

Why Work with Chamberlain?

Chamberlain Advisors is a veteran-owned business that provides human capital solutions across a wide range of industries and engagement types. Chamberlain candidates benefit from our unique hiring and interviewing process which has been designed to increase the likelihood that they will be successful in their job searches. This is achieved through our 5-step recruitment process, ensuring a top-of-the-line candidate experience. Find out what makes us different; apply to Chamberlain today.

Equal Employment Opportunity

Chamberlain Advisors provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, Chamberlain Advisors complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Chamberlain Advisors expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Chamberlain Advisors' employees to perform their job duties may result in discipline up to and including discharge.