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About the Role
Citizens Inc. is seeking a detail-oriented, critical-thinking individual to review proofs of loss, ensure claims are administered according to policy provisions and company practices, and collaborate effectively with others. The ideal candidate will work efficiently to meet turnaround times, be analytical, and provide prompt, fair payment of legitimate claims.
Responsibilities
- Answer and respond to inbound telephone inquiries from policy beneficiaries or their representatives, providing excellent service.
- Correspond with agents, policyholders, hospitals, doctors, attorneys, beneficiaries, and claimants for claim information.
- Correspond with customers for resolution of concerns through outgoing calls or written communications.
- Maintain communication with management regarding assigned responsibilities and perform special projects.
- Develop and maintain positive working relationships with internal and external stakeholders.
- Review policy contracts to determine coverage applicability.
- Review and prepare claims for processing and update claims information in the claims application.
- Determine base payment by referring to policy coverage and limits, deciding on the course of action (payment, further investigation, or denial).
- Assess, research, and correct claims discrepancies, collaborating with team members as needed.
- Maintain claims information in the claims application.
- Maintain assigned follow-ups and pending inventory.
- Process verifications and manage the verification inventory.
- Maintain complete confidentiality of company business.
- Participate in educational seminars, webinars, and local claims meetings.
- Cross-train on various product processing within the claims department.
- Exercise approval limits and release authority, which vary with experience level.
- Comply with HIPAA and other privacy regulations.
- Meet minimum qualitative standards for a Domestic Claims Analyst I, including financial accuracy (99.5%), payment accuracy (98%), and procedural accuracy (95%).
Requirements
- Bachelor’s degree preferred, or equivalent insurance-related work experience and strong computer skills.
- Courses in business, finance, economics, and mathematics are helpful.
- Complete LOMA 1 & 2 (280 & 290) courses, Associate, Customer Service (ACS) designation, and work toward the Associate, Life & Health Claims designation (ALHC).
- Associate, Life & Health Claims (ALHC) and Associate, Life Management Institute (ALMI) certifications are necessary for advancement to a claims manager position.
- Proficiency in Microsoft Office products.
- Excellent analytical, organizational, and interpersonal skills.
- Well-developed written and verbal communication skills.
- Strong math and/or financial skills.
Skills
- Detail-oriented mindset
- Critical thinking
- Initiative
- Consultative work
- Analytical skills
- Decision-making
- Administrative skills
- Process management
- Cross-training
- Skill development
- Microsoft Office
- Organizational skills
- Interpersonal skills
- Written communication
- Verbal communication
- Math skills
- Financial skills
Experience Level
- Approval limit will vary with experience level
- Release authority up to a certain amount
- Release authority no more than $10,000
Education Level
- Bachelor’s degree preferred
- Associate, Customer Service (ACS) designation
- Associate, Life & Health Claims designation (ALHC)
- Associate, Life & Health Claims (ALHC) certification
- Associate, Life Management Institute (ALMI) certification
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Short-term disability
- Long-term disability
- Accidental Death & Dismemberment (AD&D)
- Group term life insurance
- Matching 401k
- Virtual Visits
- Employee Assistance Program
- Generous Paid Time Off
- Holidays
About the Company
- Citizens Inc. offers the opportunity to make a meaningful difference in the lives of customers, communities, and colleagues.
- Fosters a culture of camaraderie where ideas are valued and collaborative efforts drive innovation.
- Rewards professional growth and recognizes individual contributions and achievements.
- Takes a complete approach to employee well-being.