What are the roles and functions of an insurance claims examiner?

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Most of the time, sales comes to mind on the subject of employment in insurance companies. However, the latter have a lot in common with most corporations in terms of departments. They have finance departments, human resources, logistics, marketing, and so on.

And like other industries, the insurance sector is host to unique jobs. According to Delos H. Yancey, president, chairman, and CEO of State Mutual Insurance, an insurance claims examiner is one of these unique positions answering for the following roles and functions:

The bulk of work of an insurance claims examiner is centered on investigating insurance claims. The insurance claims examiner validates the claims made by a policy holder before the insurance company can process a payout.

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An insurance claim is handed to an investigator if the insurance agent deems an incident worthy of examination. For example, a client that had unnecessary health treatments or has an unclear cause of death warrants an investigation.

There is also a great deal of administrative work handled by insurance claims examiners. They have to encode claims payments or payouts, revise claims and attach accompanying documents for these accounts, file, organize, and maintain an inventory of claims that need further analysis, and so on.

Insurance examiners aren’t just employed by insurance companies. According to Delos H. Yancey, the U.S. Bureau of Labor Statistics showed that while 32% of examiners in 2010 were employed by insurance companies, 18% worked for the government and 17% worked in insurance-related companies.

Led by Delos H. Yancey III, State Mutual Insurance helps older Americans maintain a sense of security through products designed specifically for their benefit. The mutual insurance company has been serving insurance policy holders for over 75 years—longevity that is testament to the quality of its products. Visit the company's website for more on its services and history.

The truth about life insurance policies

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People avail of health and life insurance policies to get them and their loved ones covered. However, it’s not enough to maintain that coverage. To experience the best care, it’s important to keep the insurance policies up-to-date with the current state of one’s life.

Updating insurance policies means taking a look at it every now and then to see if the provisions are still appropriate for one’s needs. If there are any changes in a policyholder’s income, the policy must be updated. A significant rise in one’s income—according to State Mutual Insurance’s CEO and president Delos H. Yancey—could mean a jump in the amount they are insured for.

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When a policyholder transfers to another city, their insurance policy must be updated accordingly, especially when the policy has been made to finance their mortgage commitments. The cost of growing a family will increase once a policyholder has more children. One major factor for reviewing and updating policy is the birth of children. In this day and age, remarriages have become more common. Updating the beneficiary in the policy is integral for this matter.

A boom in the property market may increase the premium. Delos H. Yancey says that policyholders advanced in age usually take out life insurance to assist their families in meeting any inheritance tax bills that are payable on their properties. While it may seem as though reviewing and updating a life insurance policy is a one-time activity, it isn’t, and it requires much attention from the policyholder.

Delos H. Yancey III is the president and CEO of State Mutual Insurance. He is a Certified Financial Examiner, a Certified Insurance Examiner, and a fellow of the LIMRA Leadership Institute. Head over to this page for more information.

A closer look at a claims reserve

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Delos H. Yancey has a passion for helping senior citizens during retirement, and he does so through his company, State Mutual Insurance. He believes that above all, knowledge of insurance and everything surrounding it is key.

On that note, here’s a topic Mr. Yancey has touched on a few times before – claims reserve, also known as a balance sheet reserve.

A claims reserve by definition is funds an insurance company has kept to be used in the future. This money is often used to settle claims that have yet to be settled. On balance sheets, claims reserves are viewed as a liability, but in reality, they are more akin to a safety net.

Claims reserves exist because of the extended amount of time it typically takes to process a claim, and because claims have to be covered. Policyholders usually receive money from claims reserves.

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 On the flip side, claims reserves come from premiums, which can be a burden to policyholders in the form of payment obligations. However, insurance companies do all they can to balance the amount charged from policyholders with history and the current market as factors. Insurance companies generally shoulder the cost in the event of an unforeseen occurrence such as an accident. This is why claims reserves are set aside.

For Delos H. Yancey of State Mutual Insurance, claims reserves are a way for insurance companies to settle what they owe policyholders in the future.

Led by Delos H. Yancey III, State Mutual Insurance helps older Americans maintain a sense of security through products designed specifically for their benefit. For more information on State Mutual Insurance, visit its official website.

A walkthrough on the factors that affect health insurance premium

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Health insurance is the most necessary protection plan when one decides to buy an insurance protection for oneself and family members. To save oneself from financial trouble emerging from health issues or emergency in the future, it’s important to purchase a best-rated health insurance plan.

Before buying a health insurance plan, one must always compare the cost and benefits offered by different insurers. Playing a critical role in the purchasing process of family health insurance, premium amounts are affected by a number of factors. One’s premium amount is less if purchased at a young age. It is the most decisive factor that has an impact on the cost of a premium. Location also affects one’s premium rate; people who live in metropolitan cities are more prone to health issues, with medical costs being more expensive in such areas. 

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Family size matters, and the family floater sum assured is extended to one family including spouse and children. While the cost incurred in purchasing a family floater does not break the bank, a family of four will have to pay a higher premium amount compared to a family of two.

Gender plays a role in health insurance premiums, and women are charged more by insurers, as they believe that women use more pharmaceuticals, see the doctor more often, and are more vulnerable to chronic illnesses. In addition, pregnancy is factored in the premium. Family medical history may be used as justification for higher health insurance premiums. The nature of one’s work also plays a role in affecting premium amounts, especially for jobs involving high injury rates, hazardous chemicals, international business travel, and others.

Delos H. Yancey III is the president and CEO of State Mutual Insurance, a legal reserve mutual insurer headquartered in Rome, Georgia. For more information about the company and its work, head over to this website.

The importance of travel insurance

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Travel insurance is often overlooked, especially when vacationers or backpackers get too caught up on costs and other travel-related expenses. There are many advantages to getting a travel insurance policy before setting off on a vacation. Below are some of them.

It covers you against travel risks. A good travel insurance will spare you from going crazy when situations such as lost or stolen luggage, flight cancellations, and unexpected hospital visits happen while you travel. It will give you peace of mind and, more importantly, a stress-free vacation.

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It gives you health coverage in remote areas. If you consider yourself as an offbeat traveler, you will find yourself in remote areas with limited medical facilities. In case you suffer from a sudden illness or get into an accident in a remote area, your travel insurance will ensure your recovery no matter where you are, even if it means getting you airlifted or shuttled.

It gives you peace of mind in terms of personal liability. In case you find yourself in a legal dispute while traveling or battling losses against unforeseen eventualities, a travel insurance can cover you. It keeps you from any worry as you hop from one place to another, as well as ensures a hassle-free (and charge-free) holiday.

State Mutual Insurance has been in business for over 75 years. A legal reserve mutual insurer, the company does not have stockholders, but is run for the benefit of and owned by its policyholders. In recent years, it has been helping older Americans maintain a sense of security with products designed specifically for their benefit. State Mutual’s current primary product is Medicare Supplement Insurance. For more information, visit the company’s website.

A walkthrough on the factors that affect health insurance premium

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Health insurance is the most necessary protection plan when one decides to buy an insurance protection for oneself and family members. To save oneself from financial trouble emerging from health issues or emergency in the future, it’s important to purchase a best-rated health insurance plan.

Before buying a health insurance plan, one must always compare the cost and benefits offered by different insurers. Playing a critical role in the purchasing process of family health insurance, premium amounts are affected by a number of factors. One’s premium amount is less if purchased at a young age. It is the most decisive factor that has an impact on the cost of a premium. Location also affects one’s premium rate; people who live in metropolitan cities are more prone to health issues, with medical costs being more expensive in such areas.

Family size matters, and the family floater sum assured is extended to one family including spouse and children. While the cost incurred in purchasing a family floater does not break the bank, a family of four will have to pay a higher premium amount compared to a family of two.

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Gender plays a role in health insurance premiums, and women are charged more by insurers, as they believe that women use more pharmaceuticals, see the doctor more often, and are more vulnerable to chronic illnesses. In addition, pregnancy is factored in the premium. Family medical history may be used as justification for higher health insurance premiums. The nature of one’s work also plays a role in affecting premium amounts, especially for jobs involving high injury rates, hazardous chemicals, international business travel, and others.

Delos H. Yancey III is the president and CEO of State Mutual Insurance, a legal reserve mutual insurer headquartered in Rome, Georgia. For more information about the company and its work, head over to this website.

How to maximize MediGap insurance

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Also known as MediGap, Medicare supplement insurance helps take the costs not included in the coverage provided by original Medicare. Taken together, the two policies can help pay for a broad assortment of medical bills and reduce the amount of out-of-pocket medical expenditures. For many older adults, MediGap insurance is an excellent investment, providing the coverage necessary to prevent surprise hospitalization expenses.

Medicare supplement insurance coverage, however, can vary broadly. It is also important to remember that MediGap insurance cannot cover long-term care costs, nor can it pay for dental care, vision care, and, in many cases, prescription drugs. Moreover, MediGap coverage is individual; for your spouse to be covered, you would need to buy one.

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Many companies offer a basic package of MediGap insurance policies that come in lettered plans. Despite differences in other individual offerings, which vary by the company, each type of lettered plan has a mandated set of fixed benefits that are uniform throughout multiple states, with few exceptions. MediGap providers in Massachusetts, Minnesota, or Wisconsin are subject to different governing laws.

Some standard plans (E, H, I, and J) can no longer be purchased by new subscribers, and the previous standard plan of choice in the past few years, Plan F, is being discontinued in 2019. In the past, many people have preferred MediGap Plan F because of its comprehensive coverage; Plan G is a recommended alternative that offers similar coverage.

For individuals under original Medicare, the best times to acquire MediGap insurance are within at least a day after one’s 65th birthday or up to six months of signing up for Medicare Plan B. This would allow them to guarantee their coverage and purchase it at the best price available.

Delos H. Yancey is the CEO of State Mutual insurance, which provides coverage for policyholders across 44 states and the District of Columbia. Visit his company’s website for more on its policies.