Claim Tech; Workplace Solutions - Remote

Pay Competitive

Employment type

Full-Time

• Req#: 502360

Ensures the accurate, prompt and thorough evaluation of Group Claims (Stable and Mature Benefits LTD) by analyzing and determining the appropriate action steps while adhering to both internal and external regulations and ensuring an industry leading customer experience. This role has a direct impact on the success of BSD from both a financial and persistency (customer retention) perspective.

The Benefit Claim Tech makes initial claim determinations with minimal ongoing claims management. Performs end to end claims evaluation and adjudication for Group Claims beginning at the point of notification through the maximum benefit / duration of the claim, with the primary accountability being accurate and timely decision making of approved or denied liability benefits for the duration of the claim, as well as communicating decisions both verbally and in writing to claimants and employers.

Demonstrates the ability to develop independent decision making and critical thinking. Claims analysis includes: eligibility determination for benefits, contract analysis, customer service, fraud detection and awareness, financial calculations, analyze and interpret medical information and adhering to all statutory/governmental regulations. This includes analyzing information received and determining if additional information is required to make a benefits decision. This position regularly communicates with employers, claimants and with medical professionals.

WHAT YOU'LL DO:

• Demonstrates the ability to make sound recommendations and working towards independent decision making throughout the life of the claim based upon claim facts, thorough evaluation, and gathering pertinent information to formulate appropriate action plans.
• Develops file that demonstrates appropriate decision making was used based on documented procedures using claim facts, pertinent policy provisions, customer expectations and special handling agreements.
• Develops appropriate business relationships and communications with claimant, broker, sales organization, vendor partners, employer and internal partners (e.g. underwriting, legal, etc.). Ensures communications demonstrate professionalism that supports the values of Mutual of Omaha.
• Initiates regular and appropriate communication with claimants, employers and medical professional(s) throughout the life-cycle of the claim.
• Accurately determines financial liability based on salary, other income sources, medical / vocational information and contract language.
• Communicates any changes in claim status to claimants, policyholders, and appropriate Home Office departments.
• Provides various updates to policyholders per contract requirements with a high level of customer service.
• Determines eligibility based on contract language, payroll records, and other supporting documentation.
• Adheres to ERISA and other federal/state laws concerning group disability insurance.
• Demonstrates flexibility and ability to support unique customer requirements.
• Creates written letters for the purpose of providing concise explanations to claimants regarding claims determinations.
• Remains abreast to industry changes, federal and state legislation and regulations, as well as changes in internal processes and procedures.
• Analytical and critical thinking skills.

ABOUT YOU:

• You help promote a culture of diversity and inclusion within the department and the larger organization. You value different ideas and opinions. You listen courageously and remain curious in all that you do.
• You are able to work remotely and have access to high-speed internet.
• Must be located in United States or Puerto Rico.
• This position is multifaceted and diverse, requiring many different skill-sets in order to be effective including :
• Ability to develop an understanding of complex insurance provisions and contracts.
• Ability to comprehend and apply insurance regulations to claim situations.
• Ability to analyze and interpret vocational and medical information to formulate a claims decision.
• Ability to communicate professionally with a high level of customer service (written and verbal).
• Demonstrate the ability to calculate basic to complex benefits based off contract provisions.
• Good organizational skills, attention to detail with a high degree of accuracy, and the ability to work towards a level of independence and apply a sense of urgency.
• Ability to meet deadlines.
• Ability to move from dependent to independent tasks and decision-making.
• Ability to diffuse situations and escalate when necessary.
• Ability to adapt to a changing environment.
• Basic knowledge of medical terminology.
• Analytical and decision-making skills.
• Proficient with personal computer, Microsoft applications and Mutual of Omaha proprietary applications (ex. GSAP, Fineos).
• Ability to maintain regular and predictable attendance in adherence to department and company attendance expectations.

We value diverse experience, skills,…