Claims Specialist 1- Remote

The Claims Specialist 1 is responsible for processing, reviewing, and adjusting routine life or health claims.

ESSENTIAL FUNCTIONS
Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

• Review, analyze and process claims, adjustments, coordination of benefits and refunds on routine life or health claims including accurate entry of codes and data to applicable system. Work may be reviewed for accuracy and more complex claims referred to a more experienced specialist.
  • Life - responsible for final expense or preneed products.
  • Health - responsible for Medicare Supplement, Dental or Hospital Indemnity or other related products.
• Respond to general inquiries by agents, policyholders, and providers concerning policy coverage and other related information by phone, email, letter or other communication channels.
• Health - Cross train on one or more other products and/or back up medical records, transmittal, provider files or other related duties.

Performs other related duties as necessary or assigned.

SUCCESS PROFILE
Knowledge, Skills, and Abilities

• Demonstrate the Wellabe core competencies of change, communication, customer focus, financial acumen, innovation, teamwork, critical thinking, and decision making. For a full description of each competency, please visit wellabe.com/core-competencies.
• Embrace and foster a diverse and inclusive culture that aligns with our commitment to THRIVE Toolkit: We are building resources for employee reference, including a diversity driven book club, leadership training, and a culture of betterment philosophy. Hear: Every employee has a voice. We listen with attention to gain knowledge and to understand. Respect: We empower people by respecting and appreciating their differences. Inclusion: We support a collaborative workforce that promotes belonging and respect that increases participation and contribution from all employees. Value: All employees are appreciated for their uniqueness. Equity: For all.
• Demonstrate an Agile mindset* of trust, teamwork, and transparency and capability to implement agile tools into daily work, allowing for quick adaption to change. (*An agile mindset is the set of attitudes supporting an agile working environment including trust, teamwork, transparency, respect, improvement, ongoing learning, pride in ownership, focus on delivering value, and the ability to adapt to change.)
• Embrace our culture of betterment, which surrounds the question: Does this decision fit with our mission and core values while enhancing the outcome for our customers, our business, and our associates.
• General knowledge of the principles, processes, and practices related to claims processing including local, state, and government insurance-related policies.
• Strong verbal and written communication skills.
• Intermediate computer skills with basic knowledge of MS Office Suite (Excel, Word, and PowerPoint).
• Ability to meet or exceed all procedural, financial and quality metrics including production standards, adjudications, quality, state and federal compliance regulations, etc.
• Acts in accordance with all HIPAA Privacy and Security guidelines to ensure confidential handling of protected health information.
• Demonstrate the American Enterprise core competencies of change, communication, customer focus, financial acumen, innovation, teamwork, critical thinking, and decision making. For a full description of each competency, please visit americanenterprise.com/core-competencies.
• Embrace and foster a diverse and inclusive culture that aligns with our commitment to THRIVE Toolkit: We are building resources for employee reference, including a diversity driven book club, leadership training, and a culture of betterment philosophy. Hear: Every employee has a voice. We listen with attention to gain knowledge and to understand. Respect: We empower people by respecting and appreciating their differences. Inclusion: We support a collaborative workforce that promotes belonging and respect that increases participation and contribution from all employees. Value: All employees are appreciated for their uniqueness. Equity: For all.
• Agile mindset* of trust, teamwork, and transparency and capability to implement agile tools into daily work, allowing for quick adaption to change. (*An agile mindset is the set of attitudes supporting an agile working environment including trust, teamwork, transparency, respect, improvement, ongoing learning, pride in ownership, focus on delivering value, and the ability to adapt to change.)
• Embrace our culture of betterment, which surrounds the question: Does this decision fit with our mission and core values while enhancing the outcome for our customers, our business, and our associates?

EDUCATION AND EXPERIENCE

Education

• High school diploma or GED equivalent.

Experience

• Previous related experience, a plus.

TRAVEL REQUIREMENTS

Travel Required? Yes

Type - Trainings/Seminars/Conferences

Percentage -Minimal

PHYSICAL REQUIREMENTS

• Primarily works in an office environment (or in-home office) performing work that is sedentary which involves remaining stationary and working on a computer for long periods of time
• Must be able to review, assess, and/or analyze data and figures by viewing a computer screen, including extensive reading.
• Regularly communicates with others in-person, via video conferencing, electronically (including email), or by phone to exchange accurate information.
• Primarily works in an office environment (or in-home office) performing work that is sedentary which involves remaining stationary and working on a computer for long periods of time.
• Must be able to review, assess, and/or analyze data and figures by viewing a computer screen, including extensive reading.
• Regularly communicates with others in-person, via video conferencing, electronically (including email), or by phone to exchange accurate information.

This job description does not list all activities, duties, or responsibilities that may be required. The employee in this position may be assigned other duties at any time with or without notice.

This job description does not constitute a contract of employment and the company may exercise its employment-at-will rights at any time.