You spend at least a third of your day at your job. You might as well spend it doing something you really love while working with a team you really enjoy being with, right? That’s the kind of atmosphere we offer at Pekin Insurance—fun, fast-paced, gratifying, supportive, and collaborative.

Of course, it’s not all fun and games. Insurance is a serious business, and we pride ourselves on making people’s lives whole again after a major disaster or even a fender bender. It’s that sense of helping people that makes our team want to do our best every day.

If you want to be excited about starting your workday and are ready to make a real difference in people’s lives, this could be the right spot for you.

See what Pekin Insurance has to offer by viewing a short video here.

Position Overview

The Claim Specialist analyzes and determines coverage benefits regarding Pre-Need, Medicare Supplement, and/or other specialized product lines based on policy and/or government plan guidelines. This position is responsible for inputting claim data into the claim system and processing all assigned claims within certain monetary limits, turnaround, and accuracy requirements.

This position will handle phone calls on claim related matters. Some remote work is available after completion of training and if in good standing with audit and turnaround expectations. May perform other duties as assigned. Rotational coverage until 5 p.m. will be required.

Essential Job Functions

• Settles assigned claims while adhering to turnaround and accuracy requirements and corresponds with necessary parties in various formats
• Interprets policy provisions and/or government plans, applies appropriate coverage, determines appropriate payee, evaluates necessary claim documentation, and identifies and reports potential fraud
• Provides high levels of customer service to consumers, including but not limited to insureds, agents, providers, funeral directors, and beneficiaries
• Enters and interprets claim data accurately from multiple types of sources into the claim system
• Verifies system is adjudicating benefits as well as coding correctly prior to claim payment
• Understands and adheres to state and federal legislation in addition to policy provisions
• Handles reconsidered or corrected claims accordingly and requests refunds from appropriate parties, if applicable
• Maintains strict privacy and security of sensitive and confidential protected health information (PHI)
• Specializes in one product line but may assist with other product lines, as requested
• Holds check authority up to $5,000 dependent upon experience, audit performance, and product line
• Attends agent meetings, employee meetings, or other company events, as requested
• Performs other duties as assigned

Education & Experience

• High School diploma or equivalent required
• Typically requires 0-2 years of experience in related field

Certifications & Experience

• N/A

Knowledge, Skills & Abilities

Basic ability to:

• Communicate effectively in both oral and written form
• Work comfortably in a fast-paced work environment
• Work as a team member and follow directions
• Process and handle confidential information with discretion
• Understand complex policies and procedures
• Read and interpret insurance policy language, governmental plans, various state or federal regulations, and detailed medical reports

Basic skill in:

• Completing assignments accurately and with attention to detail
• Customer service
• Situational analysis and decision-making

Basic knowledge of:

• Microsoft Office software
• Medical, pharmaceutical, and other health service practices and terminology, along with understanding of health care billing practices and procedures
• Life insurance industry and terminology within specialized product lines

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