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Claims Analyst

Claims Analyst

Armed Forces Benefits Assoc.Lincoln, NE, US
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Job Description

Job Description

About Armed Forces Benefit Association (AFBA) and 5Star Life

In 1947, AFBA emerged from the basement of the Pentagon to solve a critical need in support of the military. More than 75 years later, our commitment to those who serve and to solving their unique problems remains core to everything we do. Founded to provide military members with a death benefit no one else would, we continue to embrace our mission and deliver benefits tailored to the real-life needs of all who serve today, including active duty, National Guard, and first responders. Providing protection to those who go in harm’s way, we ensure survivor and other benefits are available to all who serve, defend, and protect our great nation, no matter what. 5Star Life Insurance Company was founded in service and carry that mission today by committing to serve those who serve, from underwriting benefits for military and first responder families to providing coverage to the employees that keep our communities running. Our commitment to our communities – rather than the bottom line- drives our business.

We offer a flexible hybrid work environment, allowing you to enjoy the best of both worlds with 3 days in the office and up to 2 days working remotely each week. This position is in Lincoln, NE.

General Description

Be part of a dynamic forward-thinking Worksite Group Voluntary Benefits team focused on providing an elevated client experience and comprehensive portfolio of life and supplemental health products striving to deliver total health and wellbeing to employer groups and their employees.

The Claims Analyst is an operations and sales support role responsible for managing beneficiary and group relationships at point of claim. This position will be supporting the beneficiary in understanding what is needed to complete a claim, supporting an employer or service provider in understanding the claims provisions of their coverage along with being the communication point person with vendors.

Major responsibilities :

  • Claims Intake and Communication Management

Handle incoming claim-related inquiries from brokers, employer groups, service providers, and beneficiaries, ensuring clear communication of requirements and next steps.

  • Claims Adjudication and Documentation

    • Review and adjudicate voluntary health and wellness claims in accordance with contract provisions and benefit guidelines, ensuring accuracy and compliance.

  • Stakeholder Relationship Building

    • Build and maintain proactive relationships with internal teams, brokers, and employer groups to support claims processing and provide group claims experience reporting for renewals.

  • Process Improvement and Project Support

    • Participate in process reviews and support initiatives related to new product implementation, system troubleshooting, and trend identification to enhance operational efficiency.

  • Cross-Functional Collaboration and Support

    • Collaborate with Account Management, Case Managers, and Home Office Life Claims to ensure seamless communication and support across related functional areas.

    Education, Licensure, Certification, and Experience

  • Associates degree, or equivalent related work experience
  • 3 years’ work experience preferred

    • Knowledge, Skills, and Abilities

  • Self-motivated – you are a “go-getter”, minor hurdles do not prevent you from achieving your objectives
  • Strong written and verbal communication skills – you are a good, empathetic listener, clearly articulate your thoughts, and are very persuasive
  • Ability to read and understand Group Policy language and benefits
  • Ability to understand Current Procedural Terminology (CPT) medical codes
  • Organized – you easily prioritize to maximize your efforts
  • Computer skills – you are proficient with Microsoft Office, mainframe system, and using an imaging system
  • Life, Accident, Hospital Indemnity and Critical Illness product and claims proficiency
  • Ability to guide conversations and use appropriate words and tone when dealing with difficult situations while maintaining a professional demeanor
  • Strong attention to detail
  • Forward thinking with innovation in mind
  • Flexibility in adapting to changes in systems, procedures, and guidelines
  • Demonstrates complete adherence to privacy laws and company privacy guidelines, and appropriate level of concern for the safeguarding all client information
  • Believe in teamwork
  • Ability to solve problems and react quickly in case of any urgent situations
  • A helpful and supportive nature
  • Develop and maintain a positive work environment
  • Practice good work ethics and be able to lead by example

    • About 5Star Life Insurance Company

    5Star Life Insurance Company (5Star Life) is the primary underwriter of the Armed Forces Benefit Association (AFBA) member policies and is also a growing provider of group and worksite voluntary products. Its business model enables 5Star Life to serve the needs of a diverse clientele as an insurance advisor to individuals and organizations and as a trusted partner to brokers. Headquartered in Alexandria, Virginia, 5Star Life is currently licensed in 49 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa.

    Acknowledgement

    This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employee(s) will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments.

    Essential duties and responsibilities are subject to possible modification to reasonably accommodate individuals with disabilities. This document does not create an employment contract, implied or otherwise, other than an "at will" relationship.

    Benefits we offer :

  • health insurance (medical, dental, and vision)
  • flexible spending accounts (medical and dependent care)
  • 401k plan with generous employer match
  • paid time off
  • paid holidays (12)
  • life insurance
  • short- and long-term disability insurance
  • employee assistance program
  • professional development & tuition reimbursement
  • career growth opportunities
  • on-site gym and locker rooms (Alexandria, VA office only)
  • friendly, collaborative culture

    • Qualified people of all races, ethnicities, ages, sex, genders, sexual orientations, national origins, gender identities, marital status, religions, veterans' statuses, disabilities, and any other protected classes are strongly encouraged to apply. As an equal opportunity workplace, we are committed to creating an inclusive environment for all employees. AFBA and 5Star Life Insurance Company endeavors to make reasonable accommodations to the known physical or mental limitations of qualified applicants with a disability unless the accommodation would impose an undue hardship on the operation of our business. If an applicant believes they require such assistance to complete the application or to participate in an interview, or has any questions or concerns, they should contact Human Resources (hr@afba.com). EEO is the Law (Link to external DOL site). AFBA and 5Star Life Insurance Company is an Equal Opportunity Employer and an E-Verify Employer.

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    Claim • Lincoln, NE, US