At The Trustmark Companies we help people thrive. We provide products and personalized attention that engage and inspire people to maximize their health potential. We offer employee benefits customized to fit each unique business need or life circumstance. It all revolves around our belief that better health and greater financial security increase overall well-being. And with well-being comes peace of mind. Peace of mind to focus on work and family and everything else that’s important in life. Peace of mind to thrive.

Trustmark is looking for an experienced CLAIMS REPRESENTATIVE to work in our Worcester, Massachusetts office. This position requires reviewing claim files and making recommendations on the appropriate resources, claim actions and decisions appropriately as outlined in our claim philosophy and contracts.

SUMMARY: Under supervision, utilize full understanding of the claims handling process and procedures to independently adjudicate claims in accordance with policy provisions and in full compliance with state and federal laws. Enhance claim knowledge to include Critical Illness and/or Long Term Care handling.  You will work directly with your Supervisor on challenging claim situations and necessary approvals and sign-offs.  You will also review claim files and make independently recommendations for claims actions and decisions as appropriately outlined in our claim philosophy and contracts.

RESPONSIBILITIES INCLUDE:

CLAIM MANAGEMENT:

• Independent ability to manage active claims to support contractual obligations, time service and state and federal laws.
• Responsible for handling a given caseload while adhering to department time standards and quality performance.
• Independent ability to gather and review data from different sources and make responsible decisions.
• Identify claims that need additional reviews, initiate and implement the appropriate reviews under supervision.
• Actively and independently review claims  that need additional review and self-initiate and implement appropriate reviews.
• Ability to review and understand medical and financial records.
• Understand and effectively utilize various investigative tools.

CLAIM KNOWLEDGE: 

• Complete understanding of the disability policies and associated claim handling process with the ability to process claims appropriately to support our claim philosophy in accordance with policy provisions and/or state and federal laws.
• Enhance claim knowledge to include Critical Illness and/or Long Term Care claim handling process with the ability to process claims appropriately to support our claim philosophy in accordance with policy provisions and state and/or federal laws.

CUSTOMER SERVICE:

• Ability to effectively communicate and explain contract definitions to insureds both verbally and in writing.
• Provide outstanding customer service to insureds throughout their claim.

SPECIAL PROJECTS:

• Ability to participate in special projects and assignments in addition to effectively managing a caseload.

QUALIFICATIONS:

• A minimum of 3 years of claims processing experience is required; experience in disability claims preferred. 
• Proficiency in MS Word, Excel and Outlook required; experience in Access preferred.
• Bachelor’s Degree preferred.
• Ability to travel, if necessary.
• 4-5 years of prior insurance industry experience preferred.
• Good decision making abilities required.
• Strong time management skills required.
• Strong attention to detail required.

Trustmark is undergoing a company-wide renaissance that brings creative thinking, innovation and ingenuity to the forefront. We want people who take a unique approach to problem solving, seek out creative challenges and try to find new ways of doing things. Trustmark benefits include medical/dental/life insurance, insurance education classes, a very competitive 401(k) Plan that provides up to a 6% dollar-for-dollar match subject to a vesting schedule.  Join a dynamic team that will not only utilize your current skills, but will enhance them as well.

Required Skills Required Experience

Associates Degree or 3-5 years of office experience required, Bachelors degree preferred. A minimum of one to three years experience in an administrative support role, preferably in a large organization or university setting. Strong oral and written communication skills, attention to detail, problem solving, and organizational skills. Ability to demonstrate professional judgment and flexibility, and work in a fast-paced environment. Proficiency in using various information systems and programs including Excel, and Word. SAP experience preferred. Budgeting and/or accounts payable experience a plus. Proficiency in using MS Office and Adobe Acrobat.

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. We are a VEVRAA Federal Contractor