Job Description

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.

• Family Comes First Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire

• Professional Growth Opportunities: Advance your career with ongoing training and development programs.

• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.

• Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.

• Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.

Benefits & Perks

• Base compensation is only one component of your competitive Total Rewards package

• Incentive pay program (EPIP)

• Health/Vision/Dental insurance

• 6 weeks paid parental leave for new mothers and fathers

• Fertility/Adoption assistance

• 2 weeks paid caregiver leave

• 401(k) plan matching up to 5%

• Tuition reimbursement

• Health & fitness benefits, discounts and resources

The AICK Claims Specialist will administer, review, and approve or deny all types of claims, for the products marketed by AICK, to include Waiver of Premium, Term Life, Accidental Death & Dismemberment, Short Term Disability, Long Term Disability, Living Benefit Rider, Ordinary Life, Yearly Renewable Term, all Voluntary Life and Accidental Death & Dismemberment coverage. This position also plays a part in helping develop new products, answering questions regarding how the provisions of a policy are administered and serving on Ad Hoc teams representing AICK as needed.

“This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

What you’ll do

• Review, investigate, and adjudicate all claims (approval or denial) by verifying eligibility, coverage, and contract provisions, including obtaining additional information from employers, hospitals, reinsurers, and other external partners.

• Ensure claim handling complies with all regulatory requirements, including ERISA, NAIC unfair claims practices, and applicable state regulations, and that claims are processed within statutory timeframes with appropriate documentation.

• Interpret and apply policy provisions, reinsurance treaties, and group contracts to determine claim payability, reinsurer liability, and continuation of liability; partner with reinsurers to confirm determinations.

• Conduct in-depth investigations on complex or questionable claims, including coordinating with investigators or rehabilitation specialists and preparing documentation for potential legal proceedings when required.

• Manage disability claims lifecycle, including review and processing of continuance requests, evaluation of treatment plans, and assessment of rehabilitation or return-to-work options.

• Communicate claim decisions and policy provisions clearly to claimants, employers, attorneys, and regulatory bodies via phone and written correspondence, including responses to denials and inquiries.

• Manage overpayment recoveries and collections, including establishing and monitoring repayment arrangements with claimants.

• Maintain accuracy of claim accounts and systems by verifying reports, reconciling balances, making necessary adjustments, and approving claims for payment per guidelines.

• Research and respond to State Insurance Department complaints, implement corrective actions as needed, and maintain required complaint logs in compliance with regulatory standards.

• Support contract updates and product development initiatives by collaborating across departments, participating in Ad Hoc teams, and identifying operational or compliance improvement opportunities.

• Compile and report required financial and operational data, including Schedule F for the Annual Statement, management reports (e.g., claim processing time, paid claims, closed claims), and other required reporting (FICA, W-2/W-3).

• Participate in system testing for claims payment platforms, including validation of new releases and defect fixes.

What you need

Knowledge/Skills/Abilities

• Ability to analyze detailed contract provisions and make decisions based on a set of facts or criteria.

• Excellent written and verbal communication skills.

• Extensive knowledge of ERISA/FICA regulations preferred.

• High aptitude for math.

Education and Experience:

• High school diploma or equivalent required.

• Licensed Practical Nurse, Certified Nurses Aid or Certified Medical Aid license required

• Minimum of 2 years experience in a professional, clinical, or as a medical office coordinator with billing experience required.

• Minimum of 1 years’ experience working with Kansas Department of Insurance regulations for life and/or disability products preferred.

Physical Requirements

• Ability to lift and carry up to 25 pounds.

• Ability to stand or sit for extended periods.

• Ability to look at a computer screen for prolonged periods.

• Occasional walking, bending, or reaching within the office environment.

• Ability to bend, kneel, stoop, or reach.

• Ability to perform repetitive tasks.

Compensation

$27.08 - $33.85 hourly

Non - Exempt Grade 13

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

Our Commitment to Connection and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.