Health Claims Jobs (NOW HIRING)

Committed to providing life insurance solutions since 1969 in the United States and globally since 1975, Citizens, Inc. is a publicly traded company (NYSE: CIA) that has maintained a listing on the New York Stock Exchange since 2002. Operating through our insurance subsidiaries, we strategically offer traditional insurance products in niche markets to capitalize on competitive advantages. With a dedicated team of employees located in Austin, Louisiana and a global network of agents, our reach extends to Latin America, Central America, and Asia.

THE OPPORTUNITY

Title: International Claims Analyst I (Bilingual in English/Spanish)

Job Type: Full-time Non-exempt

Summary: The ability to review proofs of loss quickly, ensure claims are administered in accordance with policy provisions and the company’s practices and philosophy, and work well with others. This requires a detail-oriented mind set, critical thinker who is willing to take initiative and work consultatively with others. This person will work effectively and efficiently to meet expected turnaround times. We look for our claim examiners to be analytical and provide prompt, fair payment of all legitimate claims.

WHAT YOU WILL GET TO DO

Customer Service and Communication:

• Correspond with agents, policyholders, hospitals, doctors, attorneys, beneficiaries and claimants for information regarding the claim via email or phone call
• Correspond with customers for resolutions of concerns through outgoing calls or written communications
• Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

Claims Processing and Analysis:

• Review policy contracts and determine if coverage is applicable
• Review and prepare claims for processing; maintain claims information in the claims app
• Determines base payment by referring to policy coverage and limits, and determines course of action (i.e., payment, further investigation or denial)
• Process verifications and manage the verification inventory
• Assess, research and correct claims discrepancies, collaborate with other members of the team as needed.
• Approval limit will vary with experience level
  1. Based on experience could be approved to release up to $1000 without secondary review
  2. Have release authority no more than $10,000
• Meet and maintain the minimum qualitative standards for an International Claims Analyst I
  1. Financial accuracy: 99.5%
  2. Payment accuracy: 98%
  3. Procedural accuracy: 95%

Teamwork and Collaboration:

• Work well in a team-based environment
• Collaborate with other team members as needed
• Cross-train on various product processing within the claims department

Professionalism and Compliance:

• Maintain excellent attendance record
• Maintain complete confidentiality of company business
• Comply with HIPAA and other privacy regulations
• Obtain required certification for advancement
• Operate in a professional manner and establish rapport with stakeholders

Skills and Abilities:

• Strategic thinking and decision-making skills
• Analytical, organizational, and interpersonal skills
• Written and verbal communication skills
• Strong math and/or financial skills
• Ability to work in multiple systems and applications
• Ability to balance prompt claim settlement with accuracy
• Ability to address issues and concerns professionally
• Ability to work in a fast-paced environment shaped by innovation

• Ability to balance prompt claim settlement against the need to be accurate in determining liability for each claim.

WHAT YOU NEED TO SUCCEED

• Bachelor’s degree preferred. However, insurance related work experience and strong computer skills acceptable.

• Courses in business, finance, economics and mathematics are particularly helpful.
• Skill in Microsoft Office products
• Expected to get certification through coursework. Certification is required for advancement to Claims Examiner or claims management positions. Many options are available through LOMA, the International Claim Association (ICA) and the American College
• Complete LOMA 1 & 2 (280 & 290) courses, Associate, Customer Service (ACS) designation and working toward the Associate, Life & Health Claims designation (ALHC). Associate, Life & Health Claims (ALHC) and Associate, Life Management Institute (ALMI) certifications are necessary for advancement to a claims manager position.
• Must be fluently bilingual with the ability to read, write and speak English and Spanish.

BENEFITS (the fun stuff)

As an employee of Citizens, we promise you the opportunity to make a meaningful difference in the lives of our customers, communities, and one another. We believe in fostering a culture of camaraderie, where your ideas are valued, and collaborative efforts drive innovation. Our commitment to rewarding work extends beyond professional growth to recognize your individual contributions and achievements.

We take a complete approach to our employees' well-being. Our benefits package includes medical, dental, vision, short-term and long-term disability, AD&D, group term life insurance, and a matching 401k to secure your financial future. Our benefits plan allows for Virtual Visits and access to our Employee Assistance Program, showcasing our commitment to your health and work-life balance. Enjoy the added perks of generous Paid Time Off and holidays, ensuring you have the time to recharge and savor life outside of work. Join us and embrace a workplace that values not only your professional growth but also your personal fulfillment.

At Citizens, our employees and customers are at the heart of everything we do. Our success as a company begins with our team of employees and departments to service our customers. That's why we strive to create an environment where employees are equipped and challenged to reach their full potential.

Citizens is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, gender identity, national origin, age, disability, or veteran status. We are committed to fostering a diverse and inclusive workplace where every individual is valued, and all qualified applicants are encouraged to apply.