Claims Customer Service Representative - 1160

As a Claims Customer Service Representative, you will serve as the initial point of contact for claimants, beneficiaries, policyowners, agents, providers and other authorized parties regarding life and supplemental health claims. Additionally, you will handle incoming and returned calls, process first notice of loss, provide accurate and timely claim status information, send required correspondence and forms, and document all interactions and outcomes in the appropriate systems. This position delivers empathetic, professional service while protecting confidential information and following established claims procedures and service standards. 

This position will have the opportunity to work primarily remote with periodic time required in their assigned Company office location (Binghamton, NY or Houston, TX). If you reside in the Greater Houston or Greater Binghamton area, this may be an opportunity for you!

Description of Duties & Responsibilities:

•    Respond to incoming calls and complete return calls regarding life and supplemental health claims in a timely, courteous and professional manner.

•    Process first notice of loss for all claim types by gathering complete and accurate information, verifying available policy and claimant details, and initiating the claim in the appropriate system.

•    Explain the claims process, required documentation, and next steps in clear, understandable language while remaining within the scope of the role and established procedures.

•    Provide callers with accurate, up-to-date information regarding claim status, outstanding requirements and correspondence, using approved systems and resources.

•    Demonstrate empathy, patience and professionalism when assisting callers who may be experiencing a loss, illness or other difficult circumstances.

•    Document each call and interaction in the appropriate system, including the reason for contact, information provided or received, actions taken, commitments made and outcome.

•    During periods between calls, prepare and send follow-up letters, claim forms and other required correspondence accurately and within established service standards.

•    Access and research information across multiple systems and resources to respond to inquiries, confirm claim details and support accurate processing.

•    Route inquiries and claim-related information to the appropriate Claims team member or department for review and handling.

•    Identify questions, complaints, sensitive matters or potential issues that require additional review and escalate them promptly to the appropriate resource or management.

•    Protect confidential, personal and health information and follow all applicable privacy, security and records handling requirements.

•    Maintain current knowledge of claims procedures, products, forms, systems, and service expectations through training, reference materials and coaching.

•    Maintain established service metrics for the Claims call queue, including availability, responsiveness, call handling, and completion of required follow-up activities.

•    Perform other duties and responsibilities as needed or assigned by management.

Required skills & experience:

•    Minimum of 2 years of experience in Customer Service.

•    Experience in an insurance industry or call center environment.

•    Health insurance industry customer service experience preferred.

•    Fluency in Spanish a plus.

•    Basic knowledge of Microsoft Word and Excel.

•    Excellent written and verbal communication skills.

•    Excellent data entry skills.

•    Ability to perform work accurately and thoroughly.

•    Ability to pay close attention to detail.

•    Ability to prioritize and organize a heavy workload.

•    Ability to work a flexible schedule with occasional overtime.

Education Required: Associate’s degree in business or related field. 

Pay Range: $19.02 to $21.03 hourly

The starting pay rate for this role is based on a variety of relevant factors, including location, education, experience, and skills.

Visa sponsorship is not available for this position

Relocation assistance is not available for this position

Security Mutual is an Equal Opportunity Employer

Federal & State Labor Law Posters

About SML:

Security Mutual Life is a leading provider of life insurance, accumulation products and retirement-,

business- and estate-planning services for individuals, families and businesses. Our innovative products

help our clients meet their financial protection needs. Headquartered in Binghamton, New York, the

Company was founded in 1886 and is recognized for its longstanding history of financial strength and

stability.

We continually invest in technology. Our agents and employees are equipped with the latest tools and

deliver outstanding service to our hundreds of thousands of policyholders throughout the United States.

We are committed to our neighbors and communities. Security Mutual and its employees help support a

wide variety of community and charitable initiatives and organizations through our donations and service.

At Security Mutual our employees are among the Company’s most valued assets. We offer competitive

salary and benefits and our work environment reflects the Company’s core values of trust, respect and

integrity.