Senior Claims Specialist

National Guardian Life Insurance Company • Madison, WI

1d • Hybrid

About The Position

The Senior Claims Specialist is responsible for representing the Claims department on projects and recommending improvements to enhance cross-functional processes to drive efficiency and effectiveness. The Senior Claims Specialist effectively communicates and corresponds with external and internal customers including policyholders, agents, funeral directors, beneficiaries, physicians, and employers. Additionally, this role is responsible for completing recurring audits, assisting with written procedure maintenance, processing escalated or complex claims for various product lines/states, and additional projects as assigned. This position provides guidance to team members, assists with training and resolves escalated claims. In this role, work is performed under minimal supervision.

Requirements

• Advanced knowledge of NGL and acquisition products and procedures
• Knowledgeable of insurance policy administration systems
• Strong knowledge of claims compliance requirements
• Demonstrated ability to interpret insurance policy language
• Ability to run and edit policy administration software queries
• Ability to perform advanced searches in document workflow management software
• Demonstrated project management skills
• Excellent written and verbal communication skills
• Ability to draft professional written communication using correct grammar, punctuation, and spelling
• Strong attention to detail with a high level of accuracy
• Ability to guide and provide constructive feedback with respect and empathy
• Excellent computer skills including Microsoft Word, Outlook and Excel
• Ability to analyze and thorough problem-solving skills
• Knowledgeable of basic accounting skills
• Ability to work independently and in a team environment
• Ability to learn quickly and adeptly handle issues that arise even when unfamiliar
• Effective and efficient organizational skills and ability to manage competing demands and tight deadlines
• Typing skills of a minimum of 45 words per minute
• Required: High School diploma or GED
• A minimum of two years of claims processing or other related business experience required.
• A minimum of one year of experience reviewing and validating NGL claims required.
• A minimum of six months of NGL claims processing including Texas claims experience required.

Nice To Haves

• Preferred: LOMA Level I Certificate or ACS preferred.

Responsibilities

• Project Participation
• Actively participate and represent team in project meetings and in collaboration with the Claims Quality Assurance Analyst.
• Provide updates to various team participants and manager.
• Meet completion dates and assigned tasks.
• Research and provide in-depth and reliable information to project members.
• Complete any related system testing.
• Assist with reoccurring items including tax-related processes.
• Recommend and assist in implementing process improvements.
• Proactively identify, investigate, and provide solutions within team areas.
• Seek out information to enhance cross functional processes.
• Collaborate with other teams to ensure efficiency and effectiveness.
• Team Effectiveness
• Actively participant in group decision making, listening, and responding constructively to others.
• Serve as a back-up trainer to new and existing staff on claims adjudication and changes to existing processes.
• Ensure work performed by others is done in accordance with policy and organizational guidelines and within stated service-level agreements.
• Accurately adjudicate claims with high accuracy within defined service timelines as needed.
• Provide timely updates and issues to Team Lead or Manager as needed.
• Ensure Standard Operating Procedures are updated in collaboration with the Claims Quality Assurance Analyst, are available and disbursed to the team and others affected on agreed upon due dates.
• Provide guidance to teammates when needed in a constructive and professional manner.
• Resolve recurring accounting issues as needed.
• Assemble impromptu team meetings to discuss and prioritize work.
• Assist Team Lead in the monitoring of work distribution and turn-around times.
• Manage and adjust breaks and lunches to ensure sufficient team coverage.
• Escalated Claims Resolution
• Provide guidance and resolve complex claims for all product lines and from the state of Texas.
• Apply various problem-solving methods and tools to analyze/solve process, procedural, and system problems.
• Determine the cause of problems and formulate solutions by testing them as possible for justification and plausibility.
• Examine several alternative, risk, and benefits of possible resolutions and recommending solutions.
• Examine defined issues with ambiguous causes.
• Gather and identify needed data and petition input to help recognize the symptoms and root causes of distinct problems.
• Apply knowledge from one process to new or common situations.
• Make sound decisions based on knowledge of procedures and processes.
• Customer Service
• Provide support for escalated claims phone calls and correspondence in a professional manner.
• Communicate effectively with empathy to NGL customers verbally, in writing, and via email. Draft professional written communication, including well-structured emails, using proper grammar, formatting, and tone.
• Contact agents, funeral homes, beneficiaries, and other customers to obtain missing information when needed.
• Prepare and distribute correspondence for filing claims, requests for additional information, and claim resolution.
• Claims Audit and Compliance
• Complete recurring audits as required by business partners and compliance requirements including but not limited to Death Master File (DMF) audits, annual surveys such as the MCAS, external audits as requested by third-party companies.
• Additional Duties
• Complete assigned projects, tasks, and/or milestones by agreed upon due dates.
• Perform other related duties as requested.

Benefits

• 20 days of Paid Time Off growing to 25 days after 5 years
• 11 Paid Holidays (10 company holidays and 1 personal holiday of your choice)
• Health care, dental and vision plans
• Up to $1,500 (Family) or $1,000 (Single) annually towards a Health Savings Account
• Annual bonus based on company performance
• Paid Parental Leave
• 401(k) match up to 9%
• Paid Sabbatical after 8 years
• Paid Volunteer Time
• Education Assistance Program
• Employee Recognition Program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED