Group Claims Examiner

Horace Mann is seeking a dedicated and detail-oriented Group Claims Examiner to join our team. In this role, you’ll be responsible for reviewing, analyzing, and managing claims across multiple lines of Group Insurance, including Short-Term Disability, Long-Term Disability, Waiver of Premium, and Life claims.

The ideal candidate will bring a strong understanding of group insurance products, exceptional analytical skills, and a commitment to accuracy, customer service, and regulatory compliance. This is an exciting opportunity to make a meaningful impact by ensuring fair, efficient, and high-quality claims experience for our clients and policyholders.

Key Responsibilities

Claims Review & Processing

• Review and manage Life, Disability, and Waiver of Premium claims, ensuring compliance with company policies and regulatory standards.
• Evaluate waiting periods, verify the validity of medical providers and treatment institutions, and assess the reasonableness of fees.
• Determine claim applicability, conduct investigations, and evaluate allowable benefits under policies or certificates.
• Approve claims within assigned authority limits, escalating complex or high-value claims as necessary.
• Accurately enter and maintain claims data within the claims management system.
• Gather and verify documentation from clients, policyholders, and internal departments to ensure timely and accurate claim processing.
• Conduct detailed reviews to validate claim accuracy and identify potential discrepancies or fraudulent activity.

Customer Service & Communication

• Provide prompt, courteous, and professional service to clients, employers, broker partners, and internal stakeholders.
• Communicate effectively with claimants, beneficiaries, and business partners to resolve inquiries and ensure clarity throughout the claims process.
• Collaborate with legal, compliance, and special investigations (SIU) teams on disputed, complex, or potentially fraudulent claims.
• Maintain organized and comprehensive claim files for audit readiness and transparency.

Data Analysis & Process Improvement

• Analyze claims data to identify trends, patterns, and improvement opportunities.
• Prepare detailed reports and summaries for management review and decision-making.
• Partner with Claims Management, Underwriting, and other business units to improve workflows, reduce cycle times, and enhance overall claim handling efficiency.
• Support the development and implementation of new tools, systems, and best practices to streamline operations and improve client satisfaction.
• Stay current on industry regulations, compliance requirements, and product changes to ensure accurate and compliant claims handling.

Qualifications & Experience

• H.S. Diploma or GED equivalent, required.
• Bachelor’s degree in a related field or equivalent work experience preferred.
• 2–4 years of experience in group insurance claims processing or a related area within financial services.
• Strong understanding of insurance policies, industry regulations, and claims standards.
• Proficiency in claims management software and Microsoft Office applications.
• Excellent analytical and problem-solving skills with strong attention to detail.
• Proven ability to manage multiple priorities and deliver high-quality results in a fast-paced environment.
• Effective written and verbal communication skills for interaction with clients, partners, and internal teams.
• Commitment to continuous learning and maintaining a high level of technical and product knowledge.
• Normal office environment.
• Periodic travel may be required.

Pay Range:

• $24.09 - $37.88/hr.

Salary is commensurate to experience, location, etc.