Join Pacific Guardian Life (PGL), a trusted leader in Hawai‘i since 1961 and voted as one of Hawaii’s Best Places to Work, delivering comprehensive life insurance and employee benefits solutions. We are seeking growth-oriented professionals who are eager to make an impact and build meaningful careers in a supportive environment dedicated to continuous learning and professional development. At PGL, our mission reflects our commitment to providing security for our clients while fostering growth, opportunity, and long-term success for our employees.
Pacific Guardian Life is seeking a highly qualified and results driven individual to fill a TDI Claims Examiner 1 position in our Honolulu office. The Claims Examiner 1 is responsible for all phases of TDI claims processing. This position establishes new TDI claims accounts in the policy administration system, reviews information on the claims form for completeness and accuracy, determines eligibility requirements are met, calculates the benefit payment, and follows up on required documents needed for ongoing claims. The Claims Examiner 1 uses good judgement in dealing with confidential information and provides excellent customer service. Promote to Claims Examiner 2 upon completion of training program.
- Provides excellent customer service to PGL personnel, external customers, vendors and claimants. Service policies with an emphasis on extraordinary service.
- Creates and maintains new claim files, including closed, denied and ongoing claims.
- Reviews checks and ACH benefit payments for accuracy. Seeks management approval on payments that exceed company authorization limits. Sends copies of checks to employers upon request.
- Processes alI ongoing101claims for future payments. Verifies information with employers, physicians, claimants and, if applicable, workers’ compensation carriers. Reviews the claim and determines future benefits and continued eligibility. Calculates future payments after initial payment is made and maintains payment information in the policy administration system.
- Monitors receipt of the Supplementary Claims Report (SR) and follows up with secondary and final notices sent to the claimant. Reviews 101 claims for future payment upon receipt of the SR Determines when claims files are to be closed.
- Processes replacement checks when necessary (i.e., due to new claimant address, etc.). Responsible for handling voids, subrogation, and refunds.
- Prepares correspondences to claimant, employer, attorneys and insurance companies for subrogation liens.
- Prepares premiums/claims lost reports as requested by individual employer.
- Maintains all claimant files on SharePoint.
- Serves as a backup for new claims processing.
- Performs other duties as assigned.
- Associates degree required. Bachelor’s degree preferred.
- Insurance or general office experience related to the functions and requirements specified. Claims processing and claims examination a plus.
- Demonstrated ability of providing exemplary customer service.
- Excellent written and verbal communication skills. Must be able to effectively communicate policy information with the public, agents and personnel at all levels of the organization.
- Well organized and attentive to detail. Must be able to prioritize tasks and work well under critical deadlines with minimum supervision.
- Self-driven to solve practical problems and handle responsibilities without constant supervision.
- Ability to be flexible and responsive to unexpected demands in the workplace. Ability to handle difficult and stressful situations effectively.
- Ability to operate a personal computer and other office equipment.
- Working knowledge of Microsoft Office (e.g., Excel, Word, and Outlook).
- Work for a well-established and respected local company
- Be part of a collaborative and supportive team environment
- Opportunities for professional development and career growth
- Contribute to a company focused on protecting Hawai‘i’s families and businesses
We offer a comprehensive benefits package to support the health, well-being, and financial wellness of our team members. Our benefits include health and dental insurance, group life insurance, paid vacation, holidays, and sick leave, as well as profit sharing and a 401(k) retirement plan. We’re committed to providing a supportive work environment that values both your personal and professional growth.
Starting pay: $23 per hour
Resumes may be submitted to:
Pacific Guardian Life
Attn: Human Resources
1440 Kapiolani Blvd., Suite 1700
Honolulu, HI 96814
E-mail: [email protected] (link sends e-mail)
Fax: (808) 942-1280
For more information, please feel free to contact a member of our Human Resources department at (808) 955-2236.
We offer competitive compensation and benefits packages.
No relocation assistance provided.
This organization participates in E-Verify.
