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Mutual of Omaha Insurance Co. Benefit Claim Technician/Sr (Accident and Critical Illness) in New York, New York

Job no: 499665

Work type: Full Time Regular

Location: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming

Categories: Customer Service, Claims/Claims Processing, Remote Work

Ensures the accurate, prompt and thorough evaluation of Group Claims (Accident and Critical Illness) by analyzing and determining the appropriate action steps while adhering to both internal and external regulations and ensuring an industry leading customer experience. This role has a direct impact on the success of WSD from both a financial and persistency (customer retention) perspective.

The Benefit Claim Tech makes initial claim determinations with minimal ongoing claims management. Performs end to end claims evaluation and adjudication for Group Claims beginning at the point of notification through the maximum benefit / duration of the claim, with the primary accountability being accurate and timely decision making of approved or denied liability benefits for the duration of the claim, as well as communicating decisions both verbally and in writing to claimants and employers.

Demonstrates the ability to develop independent decision making and critical thinking. Claims analysis includes: eligibility determination for benefits, contract analysis, customer service, fraud detection and awareness, financial calculations, analyze and interpret medical information and adhering to all statutory/governmental regulations. This includes analyzing information received and determining if additional information is required to make a benefits decision. This position regularly communicates with employers, claimants and with medical professionals.

Demonstrates the ability to make sound recommendations and working towards independent decision making throughout the life of the claim based upon claim facts, thorough evaluation, and gathering pertinent information to formulate appropriate action plans.
Develops file that demonstrates appropriate decision making was used based on documented procedures using claim facts, pertinent policy provisions, customer expectations and special handling agreements.
Develops appropriate business relationships and communications with claimant, broker, sales organization, vendor partners, employer and internal partners (e.g. underwriting, legal, etc.). Ensures communications demonstrate professionalism that supports the values of Mutual of Omaha.
Initiates regular and appropriate communication with claimants, employers and medical professional(s) throughout the life-cycle of the claim.
Accurately determines financial liability based on salary, other income sources, medical / vocational information and contract language.
Communicates any changes in claim status to claimants, policyholders, and appropriate Home Office departments.
Provides various updates to policyholders per contract requirements with a high level of customer service.
Determines eligibility based on contract language, payroll records, and other supporting documentation.
Adheres to ERISA and other federal/state laws concerning group disability insurance.
Demonstrates flexibility and ability to support unique customer requirements.
Creates written letters for the purpose of providing concise explanations to claimants regarding claims determinations.
Remains abreast to industry changes, federal and state legislation and regulations, as well as changes in internal processes and procedures.
Analytical and critical thinking skills.


This position is multifaceted and diverse, requiring many different skill-sets in order to be effective including :
You help promote a culture of diversity and inclusion within the department and the larger organization. You value different ideas and opinions. You listen courageously and remain curious in all that you do.
You are able to work remotely and have access to high-speed internet.
Ability to develop an understanding of complex insurance provisions and contracts.
Ability to comprehend and apply insurance regulations to claim situations.
Ability to analyze and interpret vocational and medical information to formulate a claims decision.
Ability to communicate professionally with a high level of customer service (written and verbal).
Demonstrate the ability to calculate basic to complex benefits based off contract provisions.
Good organizational skills, attention to detail with a high degree of accuracy, and the ability to work towards a level of independence and apply a sense of urgency.
Ability to meet deadlines.
Ability to move from dependent to independent tasks and decision-making.
Ability to diffuse situations and escalate when necessary.
Ability to adapt to a changing environment.
Basic knowledge of medical terminology.
Analytical and decision-making skills.
Proficient with personal computer, Microsoft applications and Mutual of Omaha proprietary applications (ex. GSAP, Fineos).
Ability to maintain regular and predictable attendance in adherence to department and company attendance expectations.

Accident and Critical Illness product knowledge
Accident and Critical Illness claims processing skills/experience

A diverse workplace where associates feel a sense of belonging.
An organization that feels like a small, close-knit community and has the strength of a Fortune 500 company.
Tuition reimbursement, training and career development.
Comprehensive benefits plan that includes medical, dental, vision, disability and life insurance.
Flexible spending accounts for healthcare and childcare needs.
401(k) plan with a 2% company contribution and 6% company match.
Competitive pay with an opportunity for incentives for all associates.
Flexible work schedules with a healthy amount of paid time off.
For more information regarding available benefits, please visit our
Minimum: $16.00 MidPoint: $19.99 Maximum: $23.99
Pay commensurate with experience.


Mutual of Omaha serves more than 4.8 million individual product customers and 39,000 employer groups. Our legacy of stability creates an environment where every associate is encouraged to experiment, innovate and grow in their own unique career path.

From day one, you'll have the tools to be your best self at work. Here you'll do meaningful work and your talents will have a positive impact on peoples' lives as we help our customers protect what they care about and achieve their financial goals.

Each associate is a unique contributor to creating a diverse, dynamic, thriving and inclusive workplace. We want you to become engaged ... feel a sense of belonging ... and contribute to the company's exceptional future.

Join forces with a company that can AMPLIFY YOUR STRENGTHS AND EMPOWER YOUR CAREER.

For inquiries about the position or application process, contact our HR Helpline at 1-800-365-1405.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at 1-800-780-0304. We are available Monday through Friday 7 am to 4:30 pm CST we will reply within 24 hours.


To All Recruitment Agencies: We do not accept unsolicited agency resumes and we are not responsible for any fees related to unsolicited resumes.

Advertised: Oct 11, 2021 09:00 AM Central Daylight Time

Applications close: Oct 18, 2021 11:55 PM Central Daylight Time

Mutual of Omaha and its affiliates are an Equal Opportunity /Affirmative Action Employer. Qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.