Group Claims Examiner

Horace Mann

Group Claims Examiner managing claims across multiple lines of insurance at Horace Mann. Conducting reviews, ensuring compliance, and providing excellent customer service.

Posted 5/13/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $28 - $38 per hourWebsite

About the role

Key responsibilities & impact

Review and manage Life, Disability, and Waiver of Premium claims, ensuring compliance with company policies and regulatory standards.
Evaluate waiting periods, verify 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 to ensure timely and accurate claim processing.
Conduct detailed reviews to validate claim accuracy and identify discrepancies or potentially fraudulent activity.
Provide prompt, courteous, and professional service to clients, employers, broker partners, and internal stakeholders.
Communicate effectively with claimants and beneficiaries to resolve inquiries and ensure clarity throughout the claims process.
Maintain organized, audit-ready claim files that support transparency and compliance.
Partner with legal, compliance, underwriting, and SIU teams on complex, disputed, or potentially fraudulent claims.
Ensure adherence to all regulatory requirements, company policies, and service standards.
Support a consistent and compliant claims handling approach across all lines of business.
Analyze claims data to identify trends, patterns, and opportunities for improvement.
Prepare reports and summaries for leadership to support data-driven decision-making.
Partner with internal teams to improve workflows, reduce cycle times, and enhance claim outcomes.
Support implementation of new tools, systems, and best practices to improve efficiency and customer satisfaction.
Stay current on industry regulations, product updates, and compliance requirements.

Requirements

What you’ll need

High School Diploma or GED required
Bachelor’s degree in a related field or equivalent experience preferred
2–4 years of experience in group insurance claims processing or related financial services role
Strong understanding of insurance policies, claims practices, and regulatory standards
Proficiency with claims management systems and Microsoft Office applications
Excellent analytical, problem-solving, and decision-making skills
Strong attention to detail and ability to manage multiple priorities in a fast-paced environment
Effective written and verbal communication skills
Commitment to continuous learning and professional development.

Benefits

Comp & perks

Normal office environment
Periodic travel may be required

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

claims processinginsurance policiesregulatory standardsdata analysisproblem-solvingdecision-makingattention to detaildocumentation verificationclaims management systemsworkflow improvement

Soft Skills

communicationcustomer serviceorganizational skillsprofessionalismanalytical skillstime managementteam collaborationadaptabilitycritical thinkingcommitment to learning

Certifications

High School DiplomaGEDBachelor’s degree