Claims Associate (Allstate Benefits)
The world isnt standing still, and neither is Allstate. Were moving quickly, looking across our businesses and brands and taking bold steps to better serve customers evolving needs. Thats why now is an exciting time to join our team. As a leader in a corporation with 83,000 employees and agency force members, youll have a hand in transforming not only Allstate but a dynamic industry. Youll have opportunities to take risks, challenge the status quo and shape the future for the greater good.
Youll do all this in an environment of excellence and the highest ethical standards a place where values such as integrity, inclusive diversity and accountability are paramount. We empower every employee to lead, drive change and give back where they work and live. Our people are our greatest strength, and we work as one team in service of our customers and communities.
Everything we do at Allstate is driven by a shared purpose: to protect people from lifes uncertainties so they can realize their hopes and dreams. For 89 years weve thrived by staying a step ahead of whatevers coming next to give customers peace of mind no matter what changes they face. We acted with conviction to advocate for seat belts, air bags and graduated driving laws. We help give survivors of domestic violence a voice through financial empowerment. Weve been an industry leader in pricing sophistication, telematics, digital photo claims and, more recently, device and identity protection. We are the Good Hands. We dont follow the trends. We set them.Job Description
**This position will require an onsite presence once our Jacksonville office reopens.**
Job Family Summary
The Allstate Benefits' Claim Department is responsible for the day to day analysis and processing of all claim submissions and correspondence. Claim Department personnel possess knowledge on the Company's products, their state variations, and state and federal regulatory requirements.
The Claim Associate 4 is responsible for analyzing and adjudicating claims in accordance with policy provisions with minimal guidance. A claims examiner must have the ability to interpret and apply laws, rules and regulations as well as evaluate claims from initial report to final determination. They must also be able to obtain and utilize sensitive information discreetly and objectively in addition to documenting claim files with notes, evaluations and decision-making processes while achieving optimal customer service.
- Responsible for analyzing, processing, researching, adjusting and adjudicating claims which will result in payment or non-payment of a claim with minimal guidance. Products include:
- Outpatient Physician's Treatment and Wellness Claims
- Accident, Disability, Cancer, Critical Illness, Hospital Indemnity (SHOP), Group Indemnity Medical (GIM), Heart/Stroke, or Life
- Review eligibility, insurance policies, the claim form, and supporting documentation to determine if proof of loss has been established and what benefits may be available.
- Maintain quality and production standards as determined by service agreements and/or management determination of need.
- Manage time adequately to ensure proper turn around time for all tasks such as new claims, pending claims, customer service requests and audit feedback.
- Assist in identifying, investigating and reporting fraudulent claim activity to our internal fraud unit.
- Provide correspondence that is clear, concise and meets state regulations in relation to the decision they made on the claim processed.
- High School diploma
- Ability to work in a fast paced/deadline driven environment.
- Ability to work independently or in a team-oriented environment.
- Ability to interpret and apply laws, rules and regulations.
- Ability to understand Policy coverage and insurance regulation
- Strong verbal/written communication skills
- Attend training sessions as a participant
- Moderate individual decision making
- Designated individual claim authorization
- Ability to prioritize and handle multiple tasks
- Preferred medical terminology and medical claims coding knowledge
- Must have reading comprehension skills to read and apply the provisions of specific plan documents.
The candidate(s) offered this position will be required to submit to a background investigation, which includes a drug screen.
Good Work. Good Life. Good Hands.
As a Fortune 100 company and industry leader, we provide a competitive salary but thats just the beginning. Our Total Rewards package also offers benefits like tuition assistance, medical and dental insurance, as well as a robust pension and 401(k). Plus, youll have access to a wide variety of programs to help you balance your work and personal life -- including a generous paid time off policy.
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Allstate generally does not sponsor individuals for employment-based visas for this position.
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