Claims Eligibility Specialist I

Claims Eligibility Specialist I 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! Remote work eligibility is based on proximity to the office location (11001 Lakeline Blvd., STE 120, Austin, TX 78717). 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. Position Overview: As a Claims Eligibility Specialist I, you will play a critical role in reviewing and managing claims of varying complexity. You'll work closely with a collaborative team, supporting the accurate and timely processing of claims while ensuring a high-quality customer experience. This is a great opportunity for someone with a strong background in claims and a desire to grow in a fast-paced, mission-driven environment. Responsibilities: Investigate and maintain simple complexity claims, including but not limited to: Reviews and evaluates coverage and/or liability. Analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, records, or other documents) to determine eligibility claim decisions. Establishes appropriate Plan of Care according to Claim Handling Guidelines. Accurately documents claim record with eligibility details. Conveys simple claim details (coverage, decisions, expectations, etc.) to all appropriate parties, maintaining a professional demeanor in all situations. 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. Performs other duties as assigned. Qualifications: High school diploma or equivalent 1-3 years of related experience Possesses 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 work with new insurance products in a dynamic and growing company. Competitive salary and benefits Collaborative and fast-paced work environment. Professional development and growth opportunities within the insurance 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 20 days of PTO, 10 paid holidays, and paid volunteer time off. Flexible Work Options & Perks Hybrid and remote opportunities, wellness programs, and weekly paid lunch for onsite staff. Health Savings Accounts (HSA) & Flexible Spending Accounts (FSAs) Includes a company match for HSAs.

Created: 2026-03-04