Group Claims Examiner

Group Claims Examiner

Horace Mann is seeking a dedicated and detail-oriented Group Claims Examiner to join our team. In this role, you'll be responsible for reviewing, analyzing, and managing claims across multiple lines of Group Insurance, including Short-Term Disability, Long-Term Disability, Waiver of Premium, and Life claims.

The ideal candidate will bring a strong understanding of group insurance products, exceptional analytical skills, and a commitment to accuracy, customer service, and regulatory compliance. This is an exciting opportunity to make a meaningful impact by ensuring fair, efficient, and high-quality claims experience for our clients and policyholders.

Key Responsibilities

Claims Review & Processing

• Review and manage Life, Disability, and Waiver of Premium claims, ensuring compliance with company policies and regulatory standards.
• Evaluate waiting periods, verify the validity of medical providers and treatment institutions, and assess the reasonableness of fees.
• Determine claim applicability, conduct investigations, and evaluate allowable benefits under policies or certificates.
• Approve claims within assigned authority limits, escalating complex or high-value claims as necessary.
• Accurately enter and maintain claims data within the claims management system.
• Gather and verify documentation from clients, policyholders, and internal departments to ensure timely and accurate claim processing.
• Conduct detailed reviews to validate claim accuracy and identify potential discrepancies or fraudulent activity.

Customer Service & Communication

Data Analysis & Process Improvement

Qualifications & Experience

Pay Range :

Salary is commensurate to experience, location, etc.