Health Claims Examiner I

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Globe Life

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1900

💼 Consulting

🏥 Healthcare

🛡️ Insurance

💰 $250M Post-IPO Debt - Globe Life on 2024-08

Consulting • Healthcare • Insurance

Globe Life is a U. S. -based life insurance company that provides individual life insurance policies and related products through a network of agents and direct channels. The company emphasizes customer service, agent careers, and long-term financial protection for families, and is financially rated by independent analysts for strength and stability.

📋 Description

• Review and evaluate health insurance claims to determine eligibility for payment • Analyze claim documentation, including claim forms, medical records, beneficiary records, and supporting records • Verify policy status, coverage amounts, policyholder information, and premium payment history • Obtain and review additional documentation needed to complete claim evaluations • Correspond with policyholders, agents, and other interested parties regarding claim requirements and status • Contact medical facilities, providers, legal entities, policyholders, and agents to obtain required documents • Process routine health insurance claims within authority limits and service-level expectations • Identify and escalate complex, contestable, suspicious, or high-risk claims to management • Document claim activities, decisions, and communications in company systems • Ensure compliance with federal and state regulations, company policies, privacy requirements, and internal controls • Calculate claim benefits, interest, and applicable deductions • Coordinate with Legal, Compliance, Underwriting, Customer Care, Accounting, and Information Technology • Respond to customer and agent inquiries professionally, empathetically, and promptly • Maintain departmental productivity, quality, and turnaround-time standards • Participate in training, process improvement initiatives, and continuing education • Assist with special projects and other assigned duties

🎯 Requirements

• Bachelor's degree, or 2–5 years of related experience and/or training, or equivalent combination of education and experience • 1 year of experience in a claims support role • Prior experience in health insurance, claims administration, customer service, banking, legal support, or healthcare operations • Progress toward or completion of insurance industry coursework or designations such as FLMI, ALHC, or ACS • Basic understanding of health insurance products, policy provisions, claim payment processes, and state insurance regulations • Knowledge of HIPAA, privacy regulations, data security standards, and health-claims compliance requirements • Working knowledge of claim management systems, workflow applications, document imaging platforms, and Microsoft Office • Strong analytical, problem-solving, and attention-to-detail skills • Effective verbal and written communication and customer service skills, including empathy and professionalism • Strong organizational and time-management skills; ability to manage multiple claims while meeting productivity and service-level expectations • Ability to interpret policy provisions, work independently, exercise sound judgment, and adapt to changing priorities and regulatory requirements • Strong teamwork and collaboration skills • Bilingual skills a plus • Reliable and predictable attendance during the assigned shift • Ability to work full time and/or part time based on position specifications

🏖️ Benefits

• Competitive compensation designed to reflect your expertise and contribution • Comprehensive health, dental, and vision insurance plans • Robust life insurance benefits • Company-matched 401k • Pension plan • Paid holidays and time off • Parental leave • Subsidized all-in-one subscriptions for fitness, mindfulness, nutrition, and sleep • Company-paid counseling for mental health, stress management, and work-life balance • Continued education reimbursement eligibility • Company-paid FLMI and ICA courses • Discounted Texas Rangers tickets