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About the Role

This position involves learning and handling all aspects of the claim process, including processing claims, maintaining reports, guiding beneficiaries, filing for reinsurance, and providing customer service. The role requires evaluating and processing disability claims for payment or denial based on policy terms.

Responsibilities

• Review submitted claims to ensure proper guidelines and eligibility requirements have been met.
• Contact policyholders, beneficiaries, or third parties for missing information.
• Process claims for payment or denial.
• Participate in scheduled queue call handling and dedicated client telephone calls.
• Respond to basic inquiries and assist callers in understanding claims requirements and decisions.
• Process assigned claims through claims processing systems.
• Create new claims files and input claims data and payments into applicable systems.
• Process and distribute paper and electronic mail and/or faxes.
• Log data in appropriate systems and distribute to appropriate areas or virtual folders.
• Prepare claims documents for imaging, ensuring thoroughness and accuracy.
• Follow-up on outstanding requirements to comply with regulatory and state requirements.
• Distribute claim documents to assigned claim examiner.
• Assist with claims account reconciliation.
• Provide back up support to other staff.
• Provide total quality customer service and support to all internal and external customers.
• Provide professional communications via written correspondence, phone, email, fax, and in-person interactions.
• Investigate claims by searching databases for background information and interviewing claimants and witnesses.
• Consult police, hospital records, and policy files to verify claim information.
• Consult with other professionals on complex claims.
• Assist in handling claims with suspected fraudulent or criminal activity.
• Access personal information and past claims histories to establish potential fraud.
• Address inquiries on assigned claims from various parties.
• Analyze individual and departmental claim reports and take appropriate action.
• Set-up incoming claims and process daily mail to meet approved time standards.
• Ensure required follow-up is completed and claim processing is resolved within mandated time guidelines.

Requirements

• 2-3 years of related experience required.
• 1-2 years life insurance experience required.
• Experience in a customer service or insurance industry environment required.
• Intermediate experience with Microsoft Excel required.
• Basic experience with Microsoft Word required.
• 3-5 years of related experience.
• 3-5 years life insurance experience required.
• Administration experience required.

Skills

• Familiarity with medical terminology and Company products is strongly preferred.
• Experience with Sigma, E-Records, Life Support Plus, Freedom, and Lotus Notes are strongly preferred.
• Industry recognized certifications preferred.

Location

• Greater Houston area
• Greater Binghamton area

Work Type

• Telecommuting arrangement

Experience Level

• Associate Claims Examiner
• Claims Examiner

Education Level

• Associate’s degree in business required. Degree in related field of study is acceptable.

Salary/Compensations

• $20.74 to $24.00 hourly
• $22.42 to $26.00 hourly

Benefits

• Competitive salary and benefits

About the Company

• Security Mutual Life is a leading provider of life insurance, accumulation products and retirement-, business- and estate-planning services for individuals, families and businesses.
• Our innovative products help our clients meet their financial protection needs.
• Headquartered in Binghamton, New York, the Company was founded in 1886 and is recognized for its longstanding history of financial strength and stability.
• We continually invest in technology.
• Our agents and employees are equipped with the latest tools and deliver outstanding service to our hundreds of thousands of policyholders throughout the United States.
• We are committed to our neighbors and communities.
• Security Mutual and its employees help support a wide variety of community and charitable initiatives and organizations through our donations and service.
• At Security Mutual our employees are among the Company’s most valued assets.
• Our work environment reflects the Company’s core values of trust, respect and integrity.

Equal Opportunity

• Security Mutual is an Equal Opportunity Employer