Claims Representative Job at Sammons Financial Group (Sioux Falls)

Claims Representative

Responsible to provide customer service to Agents, Policyowners, Beneficiaries, ...

Location

United States , Sioux Falls

Salary:

40223.00 - 67039.00 USD / Year

Sammons Financial Group

Expiration Date

Until further notice

Requirements

Bachelor's Degree Preferred
2-4 years' Insurance or Annuity/Life Claim experience Preferred
Must have the ability to communicate effectively and tactfully with agents, policyholders and beneficiaries
Must have knowledge of and ability to maneuver through multiple information screens
Previous customer service experience preferred
Must have strong organizational skills
Strong problem solving skills
Ability to work efficiently and independently or in a team environment
Able to adapt to frequent change
An appreciation for detail and problem solving skills

Job Responsibility

Focus primarily on answering phone calls for both life and annuities lines of business from beneficiaries, agents, policyowners, 3rd parties or others by telephone using a professional and friendly approach
inquiries are also to be handled in a precise, thorough manner with attention to grammatical correctness and professional tone
Handle all incoming initial notification of claim calls by researching and reviewing the policy/contract data file to determine coverage under the policy/contract provisions and to whom the policy benefits are payable
Correspond via telephone to assist internal and external customers with claims and benefits questions in a professional and customer centric manner
Research inquiry and provide additional information using escalation process to leadership as necessary
Acquire and maintain a working knowledge of company products as they pertain to the Claims Department across line of business (life and annuity)
Acquire and maintain basic system, tax procedure and compliance knowledge as it pertains to the Claims Department
Identify, communicate and proactively work to solve problems or issues before a service breakdown or complaint occurs
Utilize multiple systems as well as Microsoft Word, Excel and Outlook
Positive professional approach

What we offer

Health, Dental, Vision, Company Paid Retirement, PTO and Holiday Pay
Employee Stock Ownership Plan (ESOP) is a 100% company-funded retirement plan
Healthy balance between work and personal lives
Friday afternoons off all year long, competitive PTO, and generous number of paid holidays
Incentive program for defined goals subject to eligibility and performance
Colleagues who support one another, model our core values, and drive our healthy, high-performing culture

Fulltime

Claims Representative

Join our Claims Academy - we are building the next generation of expert Claims A...

Location

United States , Dubuque

Salary:

Not provided

Cottingham & Butler

Expiration Date

Until further notice

Requirements

Bachelor's degree
Prior experience in an office or customer service setting
Competitive spirit
Ability to thrive in a fast-paced professional business environment

Job Responsibility

Analyze and process claims
Talk with injured employees, doctors, CEO's, and attorneys from all across the U.S.
Engage private investigators if fraud is suspected
Advise clients and negotiate settlements on their behalf
Actively manage litigation

What we offer

Most Benefits start Day 1
Medical, Dental, Vision Insurance
Flex Spending or HSA
401(k) with company match
Profit-Sharing/ Defined Contribution (1-year waiting period)
PTO/ Paid Holidays
Company-paid ST and LT Disability
Maternity Leave/ Parental Leave
Subsidized Parking
Company-paid Term Life/ Accidental Death Insurance

New

Medical Claims Representative

We are looking for a Medical Claims Representative to join our team in Pleasanto...

Location

United States , Pleasanton

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Prior experience in medical claims processing, claim administration, or medical billing is required
Bilingual fluency in English and Spanish is required for effective communication with members
Strong understanding of medical terminology and its application in billing or claims review
Knowledge of insurance verification, benefit structures, and healthcare-related policies and procedures
Ability to read and interpret billing codes, claim documents, and supporting records with accuracy
Basic proficiency in Microsoft Excel and confidence learning new claims or member information systems
Strong written and verbal communication skills with the ability to manage high-volume workloads effectively

Job Responsibility

Review, evaluate, and process medical claims with close attention to accuracy, completeness, and applicable coverage details
Enter and maintain member, enrollment, beneficiary, and medical information within internal claims systems while following established procedures
Verify insurance details and confirm benefit eligibility to support timely and correct claim handling
Interpret billing information, coding details, and supporting documentation to determine appropriate claim outcomes
Communicate with members, providers, and internal partners regarding claim status, required documentation, and benefit-related questions
Assist Spanish-speaking members by providing clear and thorough support in both English and Spanish
Apply working knowledge of healthcare benefits, policies, and regulatory guidelines when reviewing claim activity
Escalate complex or legally sensitive claim matters to leadership when additional review or direction is needed

What we offer

medical insurance
vision insurance
dental insurance
life insurance
disability insurance
401(k) plan
free online training
access to top jobs

Medical Claims Representative

We are looking for a detail-oriented Medical Claims Representative to support he...

Location

United States , Lincolnwood

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Experience handling medical claims within a healthcare, hospital, or social assistance setting
Working knowledge of medical billing processes, insurance claim workflows, and claim administration practices
Ability to verify insurance information accurately and apply coverage details to claim processing activities
Strong attention to detail with the ability to identify errors, missing information, and claim inconsistencies
Effective written and verbal communication skills for coordinating with payers and internal teams
Proficiency in maintaining accurate documentation and managing multiple claims at different stages of review
Ability to work independently in a Contract role while meeting deadlines in a high-volume environment

Job Responsibility

Review incoming medical claims for completeness, accuracy, and alignment with payer requirements before submission or follow-up
Manage billing-related claim activity by researching discrepancies, correcting documentation issues, and helping move claims toward resolution
Verify medical insurance coverage and eligibility details to support proper claim handling and reduce preventable denials
Track claim status with insurance carriers, document updates clearly, and communicate next steps to relevant internal stakeholders
Investigate denied, rejected, or delayed claims and take appropriate action to support timely reconsideration or resubmission
Maintain organized claim administration records and ensure case details are updated accurately within designated systems
Work closely with billing, administrative, and healthcare support teams to address claim questions and improve turnaround times

What we offer

Medical
vision
dental
life and disability insurance
401(k) plan

Fulltime

Medical Claims Representative

We are looking for a detail-oriented Medical Claims Representative to support he...

Location

United States , Lincolnwood

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Experience working with medical claims in a healthcare, hospital, or social assistance setting
Knowledge of medical billing processes and insurance claim workflows
Familiarity with claim administration practices and claims documentation standards
Ability to perform medical insurance verification accurately and efficiently
Strong attention to detail with the ability to identify errors, missing information, and claim inconsistencies
Effective communication skills for coordinating with team members, providers, and payers
Proficiency in managing multiple tasks and maintaining accuracy in a deadline-driven environment

Job Responsibility

Review medical claims for accuracy, completeness, and proper supporting documentation before submission or follow-up
Process billing and claim-related records while maintaining compliance with healthcare and insurance guidelines
Investigate claim discrepancies and resolve issues by coordinating with internal teams, providers, and insurance contacts
Verify medical insurance details and confirm coverage information to support timely claim handling
Maintain organized claim administration records and update case information within designated systems
Monitor claim status, track outstanding items, and follow through to support prompt resolution and payment activity
Respond to inquiries related to claims and billing matters with professionalism, accuracy, and attention to detail

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Fulltime

Customer Service And Claims Representative

For Samsung SDS in Born we are looking Customer Service & Claims Representative ...

Location

Netherlands , Born

Salary:

2500.00 - 3500.00 EUR / Month

Randstad

Expiration Date

Until further notice

Requirements

A qualification in logistics will be an advantage e.g. MBO (logistiek)
Knowledge of (Business) English
Proven experience in a customer service or claims handling role
Strong understanding of customer service principles and claims processing procedures
Excellent communication, interpersonal, and problem-solving skills
Proficiency in relevant software and CRM systems
Ability to work independently and as part of a team in a structured environment

Job Responsibility

Handle incoming customer inquiries and provide prompt, accurate information regarding services and products
Act as the central point of contact, liaising with customers, internal teams, and external carriers to gather, manage, and follow up on claims and related queries
Collect and document information to accurately assess the validity of incoming claims
Issue liability letters for approved claims to formally commence the settlement process, ensuring all relevant parties are promptly informed
Efficiently manage and track claims within our internal administrative systems, escalating significant cases to senior management
Oversee the timely processing of compensation payments, diligently verifying the accuracy of all financial transactions
Take ownership of the claims lifecycle, managing all financial aspects through proactive communication with customers, internal departments, and carriers
Analyze claim data to pinpoint areas for improvement and proactively propose innovative short- and long-term solutions to enhance our processes

What we offer

Flexible starting hours between 7:00-9:00
7 months Randstad, followed contract Samsung SDS
Pension plan from the first day worked
€200 monthly contribution toward health insurance
Travel allowance of € 0.23 per km
Yearly company party, barbecues, Christmas gifts

Fulltime

Claims Representative Entry Level

Join our Rapid Resolution team by leading claim investigations, assessing liabil...

Location

United States , Madison

Salary:

Not provided

Sentry

Expiration Date

Until further notice

Requirements

Bachelor’s degree or equivalent work experience
Previous insurance related and/or customer service experience is preferred
Ability to professionally communicate verbally and in writing
Ability to exercise effective time management skills
Shows technological aptitude
Associate must have the ability to travel as necessary to satisfactorily complete their job responsibilities as assigned

Job Responsibility

Gain knowledge to verify coverage, compensability, and reasonable payments by thoroughly reviewing the policy, reviewing accident details, and other pertinent information related to the claim
Develop investigative claims skills by taking and reviewing recorded statements from involved parties and witnesses, reviewing police reports, and other pertinent evidence
Build knowledge to evaluate claims exposure appropriately, establishing timely reserves
Comply with industry regulations, legal requirements, and internal company policies through thorough documentation of all decisions, correspondence, and discussions that occur throughout the life cycle of the claim
Support customers with empathy and understanding, assisting them through difficult situations and effectively communicating the claims process, ongoing claim status, and decisions, including the reasoning behind them
Ability to obtain and maintain state licensing requirements

What we offer

Scheduled Hybrid work model (Monday and Friday work from home, Tuesday through Thursday in office)
In-office workspace and materials for your home office
Laptop provided
Equipment for your home office
Meal Subsidy available for associates who report to an office
401(K) plan with a dollar-for-dollar match on your first eight percent, plus immediate vesting
Sentry University (SentryU) and Tuition Reimbursement program
Generous Paid-Time Off plan
Volunteer-Time off
Group Medical, Dental, Vision, Life insurance

Fulltime

Workers Comp Senior Claims Representative

National Interstate is looking for a Workers Comp Senior Claims Representative t...

Location

United States , Richfield

Salary:

70000.00 - 75000.00 USD / Year

Engage Cleveland

Expiration Date

Until further notice

Requirements

Bachelor’s Degree in Business Administration, Risk Management and Insurance, Finance, or a related field or equivalent experience
Generally, a minimum of 5 years of experience in property and casualty claims handling
Completion of or continuing progress toward a professional designation preferred, such as Associate in Claims (AIC)
Prefer PA NJ MA state handling experience
Works within significant limits and authority on assignments of higher technical complexity and coordination
Demonstrates strong analytical, negotiation, and problem-solving skills
Demonstrates knowledge of insurance policies, coverage, and claims handling procedures
Maintains knowledge of industry laws and regulations
Demonstrates ability to organize and prioritize caseloads, ensuring timely resolution of claims
Excellent interpersonal and communication skills with the ability to build relationships and lead negotiations

Job Responsibility

Manages an inventory of claims to evaluate compensability/liability
Plans and conducts claim investigations to confirm coverage and to determine liability, compensability and damages
Determines and negotiates appropriate claim settlements/reserves within prescribed authority
May attend arbitrations, mediations, depositions, or trials
Conveys moderately complex information regarding coverage and settlements to insureds, claimants, and external partners
Authorizes payments in accordance with assigned authority limit and ensures payments are made in a timely manner
Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements
Performs other duties as assigned

What we offer

medical, dental, and vision coverage
wellness plans
parental leave
adoption assistance
tuition reimbursement
Paid Time Off and paid holidays
a 401(k) plan with company match
an employee stock purchase plan
commuter benefits

Fulltime

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