Life & DI Claims Examiner II

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Job Summary:

Renaissance Benefits is seeking an experienced Life and Disability Claims Examiner to join our growing team!

At Renaissance, the Life & DI Claims Examiner II is responsible for evaluating and processing group insurance claims for payment or denial according to the terms and conditions of each policy. In addition, the Life & DI Claims Examiner II is responsible for handling more complex processing issues such as long-term disability claims, provide backup and processing support for team members and assist with department projects as needed.

What will this role entail?

• Review submitted claims to ensure proper guidelines have been followed and eligibility requirements have been met. Contact group policyholders, beneficiaries or other third parties for missing information.

• Consult with other professionals, such as management, senior team members, and other available resources, on complex claims.

• Communicates with the claimants and employers to set expectations regarding return to work or claim status and next steps. Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence. Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system.

• Determines benefits due, makes timely claims determinations, payments/approvals and adjustments

• Investigate claims. Search database to obtain background information and interview claimants and witnesses. Consult police, hospital records and policy files to verify information reported in a claim.

• Calculate and authorize the appropriate payment for claim or refer to manager for additional review.

• Focus predominantly on long-term disability claims processing.

• Assist in handling claims with suspected fraudulent or criminal activity. Access personal information and past claims histories to establish whether a claimant has ever attempted insurance fraud.

• Answer verbal and written inquires and customer service queued calls on Group claims from insureds, group policy holders, agents, physicians, hospital attorneys, Workers' Compensation Board, Workers' Compensation carriers, State agencies, other insurance carriers, TPA's, Reinsurers and internal staff.

• Respond to requests for information or return calls within established service guidelines.

• Adheres to determined quality standards for the handling of calls and written inquiries.

• Other duties and responsibilities as needed or assigned.

Minimum Requirements:

• Associate’s degree in business required, bachelor’s degree preferred

• 2-4 years of related industry experience preferred

• Disability and/or life insurance claims administration experience strongly preferred

• Knowledge of ERISA regulations, statutory disability claims administration, required offsets and deductions, disability duration and medical management practices and Social Security application procedures strongly preferred

• Basic proficiency in Microsoft Word/Office Suite required

• Intermediate proficiency in Microsoft Excel required

• Experience with claims management systems and electronic/paperless claims processing strongly preferred.

• Ability to perform work accurately and thoroughly

• Ability to pay close attention to detail

• Ability to prioritize and organize a heavy workload

Pay Range: $27.00-29.00/hour

The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.