Claims Verification Specialist

We are adding a Claims Verification Specialist to our team! 

Who We Are:

Since 1909, National Guardian Life Insurance Company (NGL) has been one of America’s most successful and highly rated independent life insurance companies. We specialize in a suite of innovative products for life’s journey, giving people the financial stability, careful guidance and peace of mind to lead a life filled with confidence, dignity and grace.

NGL's Core Values – integrity, dependability, collaboration, compassion and growth are a foundation of our company and help to build on the interactions we have with our policyholders, partners, funeral homes and each other. We believe in creating an inclusive, welcoming environment for all where diversity is celebrated, and everyone is encouraged to live their best, most authentic self. We offer Employee Resource Groups for employees to get involved, learn, network, and offer professional and personal development opportunities.

With over 100 years of experience, our passion is to serve people. Learn more. 

Work Environment: NGL offers a flexible work environment where employees can work fully remote, hybrid or onsite at our Madison, Wis. office. We support virtual working arrangements in certain states outside of WI.

A Day in the Life:

The Claims Verification Specialist is responsible for evaluating claims for accuracy, completeness and adherence to company policies before final distribution of payment, handling escalated claims, providing customer service and assisting with written procedure maintenance. In addition, this position processes a variety of claims and service requests along all lines of business, along with providing phone support. This position effectively communicates and corresponds with external and internal customers including policyholders, agents, funeral directors, beneficiaries, and employers. The Claims Verification Specialist displays excellent teamwork, accountability and desire to share knowledge in a positive team-oriented environment. In this role, work is performed under general supervision.

Primary Responsibilities: 

Claims Evaluation

Evaluate claims for completeness and accuracy ensuring work performed by others is done in accordance with policy, performance metrics and organizational guidelines.

Communicate outcomes with team members, team lead, and supervisor appropriately.

Provide constructive feedback to team members in a collaborative, respectful and positive learning environment.

Verify claims over the audit control threshold based on amount paid and on those that are randomly selected.

Review new hire claims while in training and recommend appropriate audit levels.

Resolve difficulties and escalate issues with suggestions for additional inquiry.

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

Claims Resolution

Resolve escalated cases when presented and be solution-driven in response.

Apply various problem-solving methods and tools to analyze and solve process, procedural, and system issues.

Determine the cause of problems and formulate solutions by testing for justification and plausibility.

Examine several alternative, risk, and benefits of possible resolutions and recommending solutions.

Examine defined issues with ambiguous causes.

Gather and identify needed data and petition input to help recognize the symptoms and root causes of distinct problems.

Utilize knowledge from one process and apply to another like process regarding common situations.

Making sound decisions based on knowledge of procedure and process reasons.

Adjudicate Claims

Accurately adjudicate a minimum number of claims per day with high accuracy within defined service timelines.

Verify proper forms are received according to state regulation.

Accurately enter and process a variety of claims ranging in complexity in accordance with written processing procedures and policies.

Accurately calculate cost basis on basic annuity claims.

Accurately review and process contestable claims including referring claim to underwriter as needed.

Follow-up timely on all claims in writing within state regulated timeframes.

Process between queues as determined by business needs.

Authorize minor exceptions (i.e., overnighting or expediting) when needed to ensure exceptional customer service and in compliance with company policy.

Claims Audit and Compliance

Complete recurring audits as required by business partners and compliance requirements including but not limited to Death Master File (DMF) audits, annual surveys such as the MCAS, external audits as requested by third-party companies.

Customer Service

Provide support for escalated claims phone calls and correspondence.

Communicate effectively with empathy to NGL customers verbally, in writing, and via email.

Draft professional written communication, including well-structured emails, using proper grammar, formatting, and tone to convey information to customers.

Actively listen and appropriately respond to others in a professional manner.

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

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

Prepare proper correspondence for filing of claims, requests for additional information, and follow up.

Process Documentation

Communicate with Claims Adjudicators on team processes and update procedures/reference material.

Reinforce processes and procedures with new and existing staff.

Provide timely updates and issues to Team Lead or Manager as needed.

Ensure Standard Operating Procedures are updated, available and disbursed to the team and others affected on agreed upon due dates.

Collaboration and Teamwork

Collaborate with colleagues to help ensure team standards are maintained and collectively work towards shared goals.

Participate in team meetings, training sessions, and group decision-making by listening and responding constructively to others.

Support colleagues by offering assistance and collaboration when needed and in a constructive and professional manner.

Coordinate personal time off, breaks, and lunches with leadership to ensure sufficient team coverage.

Foster a positive, inclusive, and cooperative team environment.

Represent Claims Team on various projects/committees.

Additional Duties

Complete assigned projects, tasks, and/or milestones by agreed upon due dates.

Perform other related duties as requested.

Essential to Your Success:

Advanced knowledge of NGL and acquisition products and procedures

Knowledgeable of insurance policy administration systems

Demonstrated ability to interpret insurance policy language

Excellent written and verbal communication skills

Ability to draft professional written communication using correct grammar, punctuation, and spelling

Strong attention to detail with a high level of accuracy

Ability to guide and provide constructive feedback with respect and empathy

Intermediate computer skills with the ability to perform tasks and work in Microsoft Word, Outlook and Excel

Ability to analyze and thorough problem-solving skills

Knowledgeable of basic accounting skills

Ability to work independently and in a team environment

Ability to learn quickly and adeptly handle issues that arise even when unfamiliar

Effective and efficient organizational skills and ability to manage competing demands and tight deadlines

Typing skills of a minimum of 45 words per minute

Education Requirements:

Minimum: High School or GED

Preferred: Other

LOMA Level I Certificate or ACS preferred

Years of Experience:

A minimum of two years of claims processing or other related business experience required.

A minimum of one year of NGL claims processing experience required.

A minimum of three years of insurance claims processing experience preferred.

What We Offer:

At NGL, we provide a comprehensive Total Rewards package that includes competitive base pay and benefits designed to offer solutions to help meet your unique life needs.

Benefits:

20 days of Paid Time Off growing to 25 days after 5 years

11 Paid Holidays (10 company holidays and 1 personal holiday of your choice)

Health care, dental and vision plans

Up to $1,500 (Family) or $1,000 (Single) annually towards a Health Savings Account 

Annual bonus based on company performance

Paid Parental Leave

401(k) match up to 9%

Paid Sabbatical after 8 years

Paid Volunteer Time

Education Assistance Program

Employee Recognition Program

And much more!

Click here to learn more about our comprehensive Total Rewards program.

NGL is committed to creating a diverse environment and is an Equal Opportunity Employer. Qualified applicants will be considered for employment without regard to race, color, creed, religion, national origin, ancestry, citizenship status, age, disability, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws.

NGL is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact [email protected].