Claims Adjudicator

Full Time
Madison, WI 53703
Posted
Job description
Overview:
The Claims Adjudicator is responsible for processing claims, effectively communicating and corresponding with external and internal customers including policyholders, agents, funeral directors, and beneficiaries. Additional responsibilities include processing various types of claims and service requests along with providing phone support accurately within or exceeding existing service goals. In this role, work is performed under general supervision. The position requires the need to conduct additional research and to accurately document all findings as deemed appropriate.

  • Open to remote work in the following states: AR, FL, GA, IL, IN, IA, KS, KY, LA, MD, ME, MN, MO, NE, NH, NJ, NC, OH, SC, TN, TX, UT, VA, WI, WY
Responsibilities:
1. Accurately adjudicate claims within stated service goals.

a. Follow established written processing procedures

b. Verify proper forms are received according to state regulation

c. Accurately enter and process:

i. Whole life

ii. Term Life

iii. Universal life & Interest sensitive

iv. Acquisition Preneed

v. Final Expense

vi. Preneed

vii. Trust claims including Tru Trust, NGL Funeral Expense Trust, and NGL Estate Planning Trust

viii. Preneed Texas including accurate reconciliation and file documentation verification.

ix. Annuities

x. Contestable claims including referring claims to Underwriting as needed.

xi. Rider claims including accidental death, child/family rider, and spouse rider.

d. Accurately calculate cost basis on basic annuity claims

e. Follow-up timely on all claims in writing within state regulated time frames


2. Provide phone support for all claims related calls and letter correspondence

a. Ability to effectively communicate, with empathy when appropriate, to our customers verbally, in writing, and via email

b. Ability to actively listen and appropriately respond to others

c. Provide phone support for claims related calls while maintaining team service goals

d. Contact agents, funeral homes beneficiaries, and other customers to obtain missing information when needed

e. Prepare proper correspondence for all steps in the claim process and as needed to respond to customer inquires


3. Team Work

a. Ability and willingness to work with others in a team environment

b. Participate in group decision making, listening, and responding constructively to others

c. Offer help to teammates when the need arises

d. Manage and adjust personal time off, breaks, and lunches to insure sufficient team coverage

e. Help ensure that team standards and goals are maintained


4. Problem Solve

a. Transfer knowledge from one process and apply it to another like process regarding common situations

b. Able to gather most needed data and petition input to help recognize the symptoms and root causes of distinct problems

c. Examine defined issues with ambiguous causes

d. Suggest alternative approaches that meet the needs or the organization, the situation, and those involved

e. Resolve difficulties and escalate issues with suggestions for additional inquiry


5. Accurately research insured status

a. Follow established written processing procedures

b. Search databases to confirm Insured status

c. Update spreadsheets and document appropriately


6. Complete assigned projects, tasks, and/or milestones by agreed upon due dates including performing other related work as requested or required


Qualifications:
Knowledge, Skills, and Abilities

  • Intermediate knowledge of NGL and acquisition products and procedures

  • Intermediate communication skills-oral and written

  • General PC and office machine knowledge

  • Typing skills of at least 45 words per minute and 5500 keystrokes per hour alphanumeric

  • Knowledge of basic accounting skills

  • Ability to work in a team environment

  • Organized and detail oriented

  • Ability to quickly search the Internet and other databases



Education Requirements

Min/Preferred

Education Level

Description

Minimum

High School or GED

Preferred

Other

LOMA Level I Certificate
LOMA ACS

Preferred

Other

Wisconsin Preneed Certification

Years of Experience

Minimum Years

Description

1

One year claims processing experience or equivalent business experience

2

Two years customer service or insurance/financial experience preferred

ADA Requirements

NGL is committed to the full inclusion of all qualified individuals. Therefore, we will ensure that all individuals with disabilities are provided reasonable accommodations to meet the physical demands in the work environment described in order to perform essential job functions successfully.

Physical Demands

Demand

Description

Frequency

Standing/Sitting

Must be able to remain in a stationary position, often standing or sitting for prolonged periods.

Frequent

Walking

Needs to move about inside the office or workspace to access file cabinets, office machinery, etc.

Occasional

Lifting/Carrying

Ability to move objects and files up to 20 pounds in all directions.
Occasional

Pushing/Pulling

Ability to exert force upon an object, or draw an object toward oneself to move or change its direction such as doors and carts.

Occasional

Use of Hands/Fingers

Operates standard office equipment such as computers, keyboards, phones, photocopiers, filing cabinets and fax machines.

Constant

Working Conditions

  • This role primarily operates in a professional office environment

Disclaimer

The responsibilities described are not a comprehensive list of each task that may be given to the employee in this role. Duties, responsibilities and activities of the position may change at any time to meet the needs of the company.

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