Claims Analyst I - Domestic

ADP, Inc.; Austin (TX); On-site; USD 42,000 - 64,000; Full time

Job summary

Citizens Inc. is seeking a Claims Analyst I - Domestic to review proofs of loss, assess coverage, and process claims with accuracy. The role emphasizes timely decisions, collaboration with internal teams, and adherence to policy provisions.

Based in Austin, TX, the position requires strong analytical and communication skills, a customer-service mindset, and familiarity with HIPAA and privacy standards. A Bachelor's degree is preferred; professional certifications are encouraged for advancement.

Qualifications

• Bachelor’s degree preferred; related work acceptable.
• Coursework in business, finance, economics, and mathematics is helpful.
• Complete LOMA 1 & 2 (280 & 290) courses and ACS designation.
• ALHC/ALMI certifications are beneficial for advancement.

Responsibilities

• Respond to inbound inquiries and provide excellent service.
• Correspond with agents, policyholders, hospitals, and claimants for claim information.
• Prepare claims for processing and update in the claims system.
• Determine base payment by policy coverage and limits.
• Maintain confidentiality and participate in trainings.

Skills

Customer service

Analytical thinking

Communication skills

Microsoft Office

Financial acumen

Education

Bachelor’s degree preferred

LOMA 1 & 2

ACS designation

ALHC/ALMI pursuit

Tools

Claims software

HIPAA compliance

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 - Domestic

Regular Full-Time Citizens Home Office, Austin, TX, US

2 days ago Requisition ID: 1149

Job Summary: Citizens Inc. is looking for someone who can review proofs of loss quickly, ensure claims are administered in accordance with policy provisions and the company’s practices and philosophy, and work well with others. This requires a detail-oriented mind set, critical thinker who is willing to take initiative and work consultatively with others. This person will work effectively and efficiently to meet expected turnaround times. We look for our claim analysts to be analytical and provide prompt, fair payment of all legitimate claims.

WHAT YOU WILL GET TO DO

Customer Service and Communication:

• Answer and respond to inbound telephone inquiries from policy beneficiaries or their representatives and provide excellent service during their claims inquiries.
• Correspond with agents, policyholders, hospitals, doctors, attorneys, beneficiaries, and claimants for information regarding the claim.
• Correspond with customers for resolutions of concerns through outgoing calls or written communications.
• Maintain communication with management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.
• Ability to develop and maintain positive working relationships with internal/external stakeholder.

Analytical and Decision-Making:

• Review policy contracts and determine if coverage is applicable.
• Review and prepare claims for processing, update claims information in the claims application.
• Determine base payment by referring to policy coverage and limits, deciding on the course of action (payment, further investigation, or denial).
• Assess, research, and correct claims discrepancies, collaborating with other team members as needed.

Administrative and Process Management:

• Maintain claims information in the claims application.
• Maintain the assigned follow-ups and pending inventory.
• Process verifications and manage the verification inventory.
• Maintain complete confidentiality of company business.
• Participate in educational seminars, webinars, and local claims meetings.

Cross-Training and Skill Development:

• Cross-train on various product processing within the claims department.
• Approval limit will vary with experience level, including release authority up to a certain amount.
• Based on experience could be approved to release up to $1000 without secondary review
• Have release authority no more than $10,000

Performance Standards:

• Ability to establish rapport and build relationships in a professional manner.
• Ability to address issues/concerns in a professional manner.
• Ability to operate in a fast-paced environment shaped by constant change and innovation.
• Ability to balance prompt claim settlement against the need to be accurate in determining liability for each claim.
• Comply with HIPAA and other privacy regulations.
• Meet the minimum qualitative standards for a Domestic Claims Analyst I
• Financial accuracy: 99.5%
• Payment accuracy: 98%
• Procedural accuracy: 95%

WHAT YOU NEED TO SUCCEED

• Bachelor’s degree preferred. However, insurance related work experience and strong computer skills acceptable.
• Courses in business, finance, economics and mathematics are particularly helpful.
• Complete LOMA 1 & 2 (280 & 290) courses, Associate, Customer Service (ACS) designation and working toward the Associate, Life & Health Claims designation (ALHC).
• Associate, Life & Health Claims (ALHC) and Associate, Life Management Institute (ALMI) certifications are necessary for advancement to a claims manager position.
• Skill in Microsoft Office products
• Excellent analytical, organizational and interpersonal skills
• Well-developed written and verbal communication skills
• Strong math and/or financial skills

BENEFITS (the fun stuff)

As an employee of Citizens, we promise you the opportunity to make a meaningful difference in the lives of our customers, communities, and one another. We believe in fostering a culture of camaraderie, where your ideas are valued, and collaborative efforts drive innovation. Our commitment to rewarding work extends beyond professional growth to recognize your individual contributions and achievements.

We take a complete approach to our employees' well-being. Our benefits package includes medical, dental, vision, short-term and long-term disability, AD&D, group term life insurance, and a matching 401k to secure your financial future. Our benefits plan allows for Virtual Visits and access to our Employee Assistance Program, showcasing our commitment to your health and work-life balance. Enjoy the added perks of generous Paid Time Off and holidays, ensuring you have the time to recharge and savor life outside of work. Join us and embrace a workplace that values not only your professional growth but also your personal fulfillment.