Group Claims Examiner

Horace Mann is seeking a dedicated and detail-oriented Group Claims Examiner to join our team. In this role, you’ll be responsible for reviewing, analyzing, and managing claims across multiple lines of Group Insurance, including Short-Term Disability, Long-Term Disability, Waiver of Premium, and Life claims. The ideal candidate brings a strong understanding of group insurance products, exceptional analytical skills, and a commitment to accuracy, customer service, and regulatory compliance. This is an exciting opportunity to make a meaningful impact by ensuring fair, efficient, and high-quality claims outcomes for our clients and policyholders while supporting Horace Mann’s mission to serve educators.

Key Responsibilities

Claims Review & Processing Review and manage Life, Disability, and Waiver of Premium claims, ensuring compliance with company policies and regulatory standards. Evaluate waiting periods, verify medical providers and treatment institutions, and assess the reasonableness of fees. Determine claim applicability, conduct investigations, and evaluate allowable benefits under policies or certificates. Approve claims within assigned authority limits, escalating complex or high value claims as necessary. Accurately enter and maintain claims data within the claims management system. Gather and verify documentation to ensure timely and accurate claim processing. Conduct detailed reviews to validate claim accuracy and identify discrepancies or potentially fraudulent activity. Customer Service & Communication Provide prompt, courteous, and professional service to clients, employers, broker partners, and internal stakeholders. Communicate effectively with claimants and beneficiaries to resolve inquiries and ensure clarity throughout the claims process. Maintain organized, audit-ready claim files that support transparency and compliance. Collaboration & Compliance Partner with legal, compliance, underwriting, and SIU teams on complex, disputed, or potentially fraudulent claims. Ensure adherence to all regulatory requirements, company policies, and service standards. Support a consistent and compliant claims handling approach across all lines of business. Data Analysis & Continuous Improvement Analyze claims data to identify trends, patterns, and opportunities for improvement. Prepare reports and summaries for leadership to support data-driven decision-making. Partner with internal teams to improve workflows, reduce cycle times, and enhance claim outcomes. Support implementation of new tools, systems, and best practices to improve efficiency and customer satisfaction. Stay current on industry regulations, product updates, and compliance requirements. Qualifications & Experience High School Diploma or GED required Bachelor’s degree in a related field or equivalent experience preferred 2–4 years of experience in group insurance claims processing or related financial services role Strong understanding of insurance policies, claims practices, and regulatory standards Proficiency with claims management systems and Microsoft Office applications Excellent analytical, problem-solving, and decision-making skills Strong attention to detail and ability to manage multiple priorities in a fast-paced environment Effective written and verbal communication skills Commitment to continuous learning and professional development Additional Information Normal office environment Periodic travel may be required Pay Range: $27.64 - $38.03/hr. Salary is commensurate to experience, location, etc. Horace Mann was founded in 1945 by two Springfield, Illinois, teachers who saw a need for quality, affordable auto insurance for teachers. Since then, we’ve broadened our mission to helping all educators protect what they have today and prepare for a successful tomorrow. And with our broadened mission has come corporate growth: We serve more than 4,100 school districts nationwide, we’re publicly traded on the New York Stock Exchange (symbol: HMN) and we have more than $12 billion in assets. We’re motivated by the fact that educators take care of our children’s future, and we believe they deserve someone to look after theirs. We help educators identify their financial goals and develop plans to achieve them. This includes insurance to protect what they have today and financial products to help them prepare for their future. Our tailored offerings include special rates and benefits for educators. EOE/Minorities/Females/Veterans/Disabled. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status For applicants that are California residents, please review our California Consumer Privacy Notice All applicants should review our Horace Mann Privacy Policy Apply To This Job