Claims Analyst I - Domestic

ADP, Inc.; Donaldsonville (LA); On-site; USD 45,000 - 60,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Disability insurance

AD&D

Life insurance

401k match

Virtual Visits

Employee Assistance Program

Paid Time Off

Holidays

Job summary

Citizens Inc. is seeking a Claims Analyst I - Domestic to review proofs of loss, determine coverage, and process payments in a timely, accurate manner in Donaldsonville, LA.

You will handle inquiries from beneficiaries and agents, coordinate with providers, and maintain claims data while adhering to HIPAA and internal policies. The role emphasizes analytical decision-making, confidentiality, and teamwork.

Qualifications

• Bachelor’s degree preferred, but insurance experience and strong computer skills are acceptable.
• Courses in business, finance, economics and mathematics are helpful.
• Complete LOMA 1 & 2 (280 & 290) courses, ACS designation, and working toward ALHC.
• ALHC and ALMI certifications are necessary for advancement to a claims manager position.
• Proficiency with Microsoft Office products.
• Strong analytical, organizational and interpersonal skills; excellent written and verbal communication.
• Strong math and/or financial skills.

Responsibilities

• Handle inbound inquiries from beneficiaries and agents, providing excellent service.
• Correspond with agents, policyholders, hospitals, doctors, attorneys, and claimants for information.
• Communicate resolutions via calls or written correspondence.
• Maintain claims information in the claims system and manage follow-ups.
• Develop positive relationships with internal and external stakeholders.
• Review policy contracts to determine coverage and prepare claims for processing.
• Determine base payment by policy limits and decide on course of action.
• Maintain confidentiality of company information.
• Participate in seminars, webinars, and local claims meetings.
• Cross-train on product processing within the claims department.
• Release authority up to specified limits depending on experience.

Skills

Analytical skills

Communication skills

Interpersonal skills

Organizational skills

Mathematical skills

Microsoft Office

Education

Bachelor’s degree preferred

LOMA 1 & 2 (280 & 290)

ACS designation

ALHC certification

ALMI certification

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

313 - HS - Austin Claims Regular Full-Time Donaldsonville, LA, US

2 days ago Requisition ID: 1151

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.