Senior LTC Claim Examiner

Physicians Mutual; Omaha (NE); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Dental insurance

Health insurance

Pet insurance

Job summary

Physicians Mutual in Omaha, NE is seeking an experienced Senior Claim Examiner to manage an assigned caseload and serve as the primary contact throughout the claim lifecycle. You will review, evaluate, and process claims while guiding policyholders, providers, and internal partners.

The ideal candidate has strong analytical and communication skills, can read and apply insurance contract provisions, and work accurately in a fast-paced setting with changing workloads.

Qualifications

• 2+ years of claims handling experience or related insurance industry experience.
• Strong knowledge of insurance policies, claims processes, and regulatory requirements.
• Ability to explain complex information clearly and manage sensitive conversations.

Responsibilities

• Manage an assigned claims caseload with timely and accurate processing.
• Review and adjudicate claims according to policy provisions and company guidelines.
• Communicate claim decisions and next steps clearly via phone.
• Handle escalated claim situations with sound judgment.
• Maintain thorough documentation in the claims system.
• Ensure compliance with regulatory requirements and quality standards.

Skills

Analytical skills

Written and verbal communication

Claims processing

Regulatory knowledge

Education

High school diploma

Associate or Bachelor’s degree preferred

Tools

Claims management system

Job description

We are seeking an experienced and detail-oriented Senior Claim Examiner to manage an assigned caseload and serve as a primary point of contact throughout the claim’s lifecycle. This role is responsible for reviewing, evaluating, and processing claims while providing clear guidance and support to policyholders, providers, and internal partners.

The ideal candidate will demonstrate strong analytical skills, sound judgment, and strong verbal and written communication skills, including exceptional phone communication abilities. This position requires the ability to confidently handle complex conversations, clearly explain coverage determinations, accurately document claim activity, and read, interpret, and apply insurance contract provisions when making claim decisions. Success in this role requires adaptability, accuracy, and the ability to manage changing workloads in a fast-paced environment.

Responsibilities Include:

• Manage an assigned claims caseload on an ongoing basis, ensuring timely and accurate processing
• Review, analyze, and adjudicate claims according to policy provisions and company guidelines
• Communicate claim decisions, requirements, and next steps clearly and professionally via phone
• Handle complex or escalated claim situations with confidence and sound judgment
• Maintain consistent follow-up with policyholders, beneficiaries, providers, and internal departments
• Document all claim activity thoroughly and accurately in the claims management system
• Interpret policy language and explain coverage determinations in a clear, understandable manner
• Identify potential issues, discrepancies, or risks and escalation as appropriate
• Maintain compliance with regulatory requirements and internal quality standards
• Meet productivity, quality, and service level expectations

Qualifications:

• High school diploma required; associate or bachelor’s degree preferred
• 2+ years of claims handling experience or related insurance industry experience preferred
• Strong knowledge of insurance policies, claims processes, and regulatory requirements
• Strong written and verbal communication skills, including the ability to explain complex information clearly and manage sensitive conversations professionally
• Ability to demonstrate critical thinking skills to evaluate claims accurately and consistently
• Ability to manage an assigned caseload with a high level of accuracy, organization, and time management
• Ability to work effectively in a fast-paced environment with shifting priorities Ability to handle confidential information with discretion and professionalism
• Proficiency in claims systems and/or standard business software
• Demonstrate ability to work independently and collaborate effectively with internal teams

About us:

Health. Life. Retirement. The Physicians Mutual family empowers people from all walks of life to enjoy the financial security they deserve. That’s what Insurance for all of us® is about.

The Physicians Mutual family includes Physicians Mutual Insurance Company and Physicians Life Insurance Company. Physicians Mutual Insurance Company offers reliable dental and supplemental health insurance (and now, pet insurance!). Physicians Life Insurance Company provides important Medicare Supplement and life insurance coverage. The company additionally offers coverage for funeral pre-planning to help meet the growing needs of funeral home owners and the families they serve.

Since our start in 1902, our dedication to delivering on our promise has helped make us one of the nation’s leading health and life insurance providers. In fact, we are rated in the top 1% of insurance companies. We consistently maintain some of the highest financial strength ratings in the nation from independent insurance analysts, including A.M. Best Company and Weiss Ratings, ensuring we’ll be there for our policyowners and our employees far into the future. But the achievement we’re most proud of? We have a 95% customer approval rating — a true sign of a company dedicated to embodying its vision