Senior Claims Specialist

We are adding a Senior Claims 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 Senior Claims Specialist is responsible for representing the Claims department on projects and recommending improvements to enhance cross-functional processes to drive efficiency and effectiveness. The Senior Claims Specialist effectively communicates and corresponds with external and internal customers including policyholders, agents, funeral directors, beneficiaries, physicians, and employers. Additionally, this role is responsible for completing recurring audits, assisting with written procedure maintenance, processing escalated or complex claims for various product lines/states, and additional projects as assigned. This position provides guidance to team members, assists with training and resolves escalated claims. In this role, work is performed under minimal supervision.

Primary Responsibilities: 

Project Participation

Actively participate and represent team in project meetings and in collaboration with the Claims Quality Assurance Analyst.

Provide updates to various team participants and manager.

Meet completion dates and assigned tasks.

Research and provide in-depth and reliable information to project members.

Complete any related system testing.

Assist with reoccurring items including tax-related processes.

Recommend and assist in implementing process improvements.

Proactively identify, investigate, and provide solutions within team areas.

Seek out information to enhance cross functional processes.

Collaborate with other teams to ensure efficiency and effectiveness.

Team Effectiveness

Actively participant in group decision making, listening, and responding constructively to others.

Serve as a back-up trainer to new and existing staff on claims adjudication and changes to existing processes.

Ensure work performed by others is done in accordance with policy and organizational guidelines and within stated service-level agreements.

Accurately adjudicate claims with high accuracy within defined service timelines as needed.

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

Ensure Standard Operating Procedures are updated in collaboration with the Claims Quality Assurance Analyst, are available and disbursed to the team and others affected on agreed upon due dates.

Provide guidance to teammates when needed in a constructive and professional manner.

Resolve recurring accounting issues as needed.

Assemble impromptu team meetings to discuss and prioritize work.

Assist Team Lead in the monitoring of work distribution and turn-around times.

Manage and adjust breaks and lunches to ensure sufficient team coverage.

Escalated Claims Resolution

Provide guidance and resolve complex claims for all product lines and from the state of Texas.

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

Determine the cause of problems and formulate solutions by testing them as possible 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.

Apply knowledge from one process to new or common situations.

Make sound decisions based on knowledge of procedures and processes.

Customer Service

Provide support for escalated claims phone calls and correspondence in a professional manner.

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.

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

Prepare and distribute correspondence for filing claims, requests for additional information, and claim resolution.

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.

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

Strong knowledge of claims compliance requirements

Demonstrated ability to interpret insurance policy language

Ability to run and edit policy administration software queries

Ability to perform advanced searches in document workflow management software

Demonstrated project management skills

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

Excellent computer skills including 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:

Required: High School diploma or GED

Preferred:  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 experience reviewing and validating NGL claims required.

A minimum of six months of NGL claims processing including Texas claims experience required.

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].