Life Claims Specialist

Why AGIA? 

AGIA Affinity is an established but growing insurance and benefits marketing partner to some of the largest and most iconic associations and organizations in the country. Our clients include many veterans' organizations and ensuring that our servicemembers have the coverages they need when they need it is at the heart of everything we do. For 66 years we have sought to improve the lives of not only our client members but our internal members as well.  

What Are The Benefits? 

AGIA offers health benefits including medical, dental, and vision, 401K with 100% company match up to 3% of your annual income and an additional 50% match on the next 2% of income, a prefunded optional FSA , 100% covered Life Insurance, Accidental Death and Dismemberment Insurance, Short Term/Long Term Disability, and a $250 Wellness Benefit. Our medical plan has in-network provider coverage for mental health, reproduction, chiropractic, and massage therapy.  

Time off: 

We offer 10 days of vacation your first year, and each year you gain an additional day. Each year, you'll be earning more vacation time at a faster rate. Every associate gets 13 paid and closed holidays each year.  

Position Summary:

The Claims Specialist I is responsible for analyzing and adjudicating claims for group Life and Accidental Death insurance plans in a timely and accurate manner and in strict accordance with defined carrier, state and federal requirements to ensure an excellent customer experience.

Essential Job Functions:

1. Research submitted claims and records regarding eligibility and compliance with the provisions of the Certificate of Coverage to ensure accurate application of coverage benefits.

2. Process Life and Accidental Death claims to ensure timely and accurate response to claimants in strict accordance with carrier, state, federal and internal compliance requirements.

3. Generate concisely written correspondence to members, insureds and providers to request required information in a timely and accurate manner and follow-up as needed.

4. Monitor and review pended claims to ensure that final claim determination and follow-up are performed in accordance with carrier, state and federal requirements.

5. Support the Member Benefits Service Department with customer inquiries.

6. Perform other miscellaneous functions and special projects as assigned.

Education/Certification:

High school degree or equivalent.

Required Experience:

One  year claims analysis and/or claims adjudication experience with Life claims processing preferred.

Required Knowledge:

Knowledge of CPT codes, RVS codes and ICD9/10 coding and medical terminology preferred.   

Skills/Abilities:

• Basic proficiency in MS Office.
• Strong attention to detail.
• Strong alpha numeric and ten-key typing skills.
• Ability to work in a fast paced and changing environment.
• Excellent customer service skills.
• Good verbal, written and interpersonal skills.
• Good deductive reasoning, problem solving and analysis skills.

Travel:

Very light out of state travel.

Work Schedule:

Regular office hours. Overtime as needed but not required.