Claims Analyst I

Assurity Life Insurance Company; Lincoln (NE); Hybrid; USD 52,000 - 76,000; Full time

Job summary

Assurity Life Insurance Company in Lincoln, NE, is seeking a Claims Analyst I to join our hybrid team. You will process health claims for health and disability products, reviewing documentation and ensuring accurate, compliant decisions.

You will liaise with internal departments, policyholders, doctors, and employers to gather required information. The role requires 4–6 years of relevant experience, strong communication skills, and careful attention to detail.

Qualifications

• Associate degree or equivalent in business or related field.
• Four to six years’ relevant experience or equivalent required.
• Professional oral and written communication skills required.
• Progress toward ALHC and FLMI designations.

Responsibilities

• Process health claims for health and disability products.
• Examine claims documentation and validate against policy and regulations.
• Serve as liaison between internal departments.
• Maintain fair claims practices and timely decisions.
• Read medical records and apply policy provisions.
• Communicate with policyholders, doctors, and employers.
• Order necessary records and documents.

Skills

Oral communication

Written communication

Decision making

Problem solving

Attention to detail

Education

Associate degree or equivalent in business or related field

Tools

LifePro

Workflow systems

Microsoft Word

Microsoft Excel

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Claims Analyst I

Full Time Lincoln, NE, US

3 days ago Requisition ID: 1442

Assurity is looking for enthusiastic, driven and collaborative people to join our team. We’re a company of vibrant and passionate people who work every day to advance our mission of helping people through difficult times – and who truly want to make a difference. As a Certified B Corporation, we have a verified commitment to our people, community and planet, and we work every day to make the world a better place.
Ample opportunities for growth, a thriving culture and coworkers who care as much as you do are just the beginning. Come work with purpose. Learn more: www.assurity.com/careers

ESSENTIAL FUNCTIONS

85% Process health claims, which may include:

• Initializing and triaging all claims for all health and disability products;
• Independently examine claims documentation such as medical bills/records, accident reports, claim forms and facility information (HCFA 1500 & UB04) and validate claims against policy coverage, state/federal regulations, and contractual requirements to determine correct claim process and decision;
• Serve as a liaison between numerous internal departments, including but not limited to customer service, accounting, legal, and others;
• Adhere to all statutory and regulatory fair claims practices;
• Making judgments within the standards of completeness, timeliness and accuracy regarding payment, denial, or investigation;
• Reading and analyzing medical records;
• Understanding and applying policy provisions;
• Composing and typing correspondence to policy holders, doctors, employers, and others as required;
• Calling claimants and/or employers for additional information;
• Ordering investigative reports, medical, financial, and other records as required;
• Paying ongoing/continuance claims within authority level;
• Referring continuance claims after 3 months of benefits have been paid to higher level; and
• Processing continuance claims when referred back from higher level.

5% Refers specified non-routine cases to team lead(s), Sr. Claims Supervisor, or higher level analysts.

10% Performs other functions as assigned, which may include:

• Answering calls referred from Contact Center;
• Helping train new associates.

The list of essential functions is not exhaustive and may be substituted as necessary.

EXPERIENCE AND SKILL REQUIREMENTS

• Four to six years’ relevant experience or equivalent required.
• Professional oral and written communication skills required.
• Consistent and reliable attendance is an essential function to this position.
• Decision-making ability required.
• Proficiency with word processing and spreadsheet software.
• Progress toward completion of ALHC and FLMI designations.
• Problem solving skills and appreciation for details required.
• Knowledge of LifePro and Workflow systems.
• Talent required in values, work intensity, achiever, positivity, resourcefulness, command, persuasion, relationship-extension, and exactness.

EDUCATION AND CERTIFICATION REQUIREMENTS

• Associate degree or equivalent in business or related field required.

PHYSICAL AND WORK SCHEDULE REQUIREMENTS

• May require work in excess of 40 hours a week in order to complete functions of position.
• Hybrid position based in Lincoln, NE. Requires three days per week onsite and provides a hybrid schedule with two remote workdays.