Health Claims Examiner I (Remote)

At Globe Life, we are committed to empowering our employees with the support and opportunities they need to succeed at every stage of their career. We take pride in fostering a caring and innovative culture that enables us to collectively grow and overcome challenges in a connected, collaborative, and mutually respectful environment that calls us to help Make Tomorrow Better.

Role Overview:

Could you be our next Health Claims Examiner I? Globe Life is looking for a Health Claims Examiner I to join the team!

This role is responsible for the timely, accurate, and professional adjudication of routine health insurance claims. This position ensures compliance with company policies, state regulations, and departmental service standards.

This position is a remote/work-from-home position.

What You Will Do:

• Review and evaluate health insurance claims to determine eligibility for payment in accordance with policy provisions, company guidelines, and applicable regulations.
• Analyze claim documentation, including claim forms, medical records, beneficiary and supporting records to establish claim validity.
• Verify policy status, coverage amounts, policyholder information, and premium payment history.
• Obtain and review additional documentation as necessary to complete claim evaluations.
• Correspond with policyholders, agents, and other interested parties regarding claim requirements and claim status.
• Contact medical facilities, providers, legal entities, policyholders, and agents to obtain necessary documents required to process claims.
• Process routine health insurance claims within established authority limits and service level expectations.
• Identify and escalate complex, contestable, suspicious, or high-risk claims to management for further review.
• Document all claim activities, decisions, and communications accurately within company systems.
• Ensure compliance with federal and state regulations, company policies, privacy requirements, and internal controls.
• Calculate claim benefits, interest, and applicable deductions accurately.
• Coordinate with internal departments including Legal, Compliance, Underwriting, Customer Care, Accounting, and Information Technology as needed.
• Respond to customer and agent inquiries in a professional, empathetic, and timely manner.
• Maintain productivity, quality, and turnaround time standards established by the department.
• Participate in departmental training, process improvement initiatives, and continuing education activities.
• Assist with special projects and other duties as assigned.

What You Can Bring:

• Bachelor's degree, or 2–5 years of related experience and/or training; or equivalent combination of education and experience.
• 1 year of experience in a claims support role.
• Prior experience in health insurance, claims administration, customer service, banking, legal support, or healthcare operations.
• Progress toward or completion of insurance industry coursework or designations (e.g., FLMI, ALHC, ACS).
• Basic understanding of health insurance products, policy provisions, claim payment processes, and state insurance regulations.
• Knowledge of HIPAA, privacy regulations, data security standards, and compliance requirements related to health claims.
• Working knowledge of claim management systems, workflow applications, document imaging platforms, and Microsoft Office.
• Strong analytical, problem-solving, and attention to detail skills with the ability to review documentation, identify discrepancies, and calculate benefits accurately.
• Effective verbal and written communication skills with excellent customer service abilities, including empathy and professionalism when assisting claimants.
• Strong organizational and time management skills with the ability to manage multiple claims while meeting productivity and service level expectations.
• Ability to interpret policy provisions, work independently, exercise sound judgment, and adapt to changing priorities and regulatory requirements.
• Strong teamwork and collaboration skills to effectively partner with internal departments such as Legal, Compliance, Customer Care, Underwriting, and Accounting.
• Bilingual skills a plus.

Applicable To All Employees of Globe Life Family of Companies:

• Reliable and predictable attendance of your assigned shift.

• Ability to work full time and/or part time based on the position specifications.

How Globe Life Will Support You:

Looking to continue your career in an environment that values your contribution and invests in your growth? We've curated a benefits package that helps to ensure that you don’t just work, but thrive at Globe Life:

• Competitive compensation designed to reflect your expertise and contribution.

• Comprehensive health, dental, and vision insurance plans because your well-being is fundamental to your performance.

• Robust life insurance benefits and retirement plans, including company-matched 401k and pension plan.

• Paid holidays and time off to support a healthy work-life balance.

• Parental leave to help our employees welcome their new additions.

• Subsidized all-in-one subscriptions to support your fitness, mindfulness, nutrition, and sleep goals.

• Company-paid counseling for assistance with mental health, stress management, and work-life balance.

• Continued education reimbursement eligibility and company-paid FLMI and ICA courses to grow your career.

• Discounted Texas Rangers tickets for a proud visit to Globe Life Field.

Opportunity awaits! Invest in your professional legacy, realize your path, and see the direct impact you can make in a workplace that celebrates and harnesses your unique talents and perspectives to their fullest potential. At Globe Life, your voice matters.