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:

• $25.58 - $37.79/hr.

Salary is commensurate to experience, location, etc.

Horace Mann was founded in 1945 by two Springfield, Illinois, teachers who saw a need for quality, affordable auto insurance for teachers. Since then, we’ve broadened our mission to helping all educators protect what they have today and prepare for a successful tomorrow.  And with our broadened mission has come corporate growth:  We serve more than 4,100 school districts nationwide, we’re publicly traded on the New York Stock Exchange (symbol: HMN) and we have more than $12 billion in assets.

We’re motivated by the fact that educators take care of our children’s future, and we believe they deserve someone to look after theirs.  We help educators identify their financial goals and develop plans to achieve them.  This includes insurance to protect what they have today and financial products to help them prepare for their future. Our tailored offerings include special rates and benefits for educators.

EOE/Minorities/Females/Veterans/Disabled. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status

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