Claims Eligibility Specialist Team Lead

Claim Eligibility Team Lead

Looking to join a growing company dedicated to helping others? We offer that, plus competitive salaries, a culture of learning, and a fast-paced environment. This is a hybrid position with 3 days in-office. Join our team to help make a difference in the lives of others! 

About Continental General:

The Continental General family of companies has provided insurance, including life and long-term care policies, to individuals and groups for over 30 years, and currently supports over 100,000 policyholders. Both our insurance company, Continental General Insurance Company, and our third-party administrator, Continental General Services, are committed to the continuous development of our infrastructure, processes, and people. The group is actively growing through expansion of both its insurance portfolio and its administrative services. With each opportunity, we take a collaborative approach to address challenges and provide unique solutions.

Job Summary:

The Claims Eligibility Team Lead will be responsible for investigating and managing insurance claims from start to finish. You will assess coverage and liability, gather and evaluate relevant documentation, and ensure timely and accurate claims resolution in compliance with legal and company standards.

Key Responsibilities:

• Investigates and maintains claims:
  • Reviews and evaluates coverage and / or liability.
  • Secures and analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, records or other documents) to assist in the investigation of claims.
• May affect settlements / reserves within prescribed limits; submits recommendations to supervisor on cases exceeding personal authority.
• Conveys moderately complex information (coverage, decisions, outcomes, etc.) to all appropriate parties, maintaining a professional demeanor in all situations
• Ensures that claims payments are issued in a timely and accurate manner.
• Ensures claims handling is conducted in compliance with applicable statues, regulations and other legal requirements, and that all applicable company procedures and policies are followed.
• May provide guidance and assistance to lower-level positions and other functional areas
• Performs other duties as assigned.

Qualifications:

• 5 years of related experience in claims management and review, with experience in the insurance industry and with related products a plus.
• Possesses a high level of technical knowledge and skills related to claims management and review
• Communicates effectively, both orally and in writing, with empathy and strong listening skills

Why Join Us?

• Opportunity to join an investment accounting function in a dynamic and growing insurance company.
• Competitive salary and benefits, including 401(k), health insurance, and performance-based bonuses.
• Collaborative and fast-paced work environment.
• Professional development and growth opportunities within the finance and investment space.

Benefits:

• Competitive Salary & Target Bonus Program
• Retirement Savings – 401(k) with a company match
• Comprehensive Medical insurance through BlueCross BlueShield of Texas. Company-paid dental, vision, short-term & long-term disability, and life insurance.
• Work-Life Balance – This role offers 20 days of PTO, 10 paid holidays, and paid volunteer time off.
• Flexible Work Options & Perks – Hybrid opportunity, wellness programs, and weekly paid lunch for onsite staff.
• Health Savings Accounts (HSA) & Flexible Spending Accounts (FSAs) – Includes a company match for HSAs.

Salary : $60,000 - $70,000