Life Claims Examiner

Position Summary: Works both independently and in a team environment in providing claim service to policyholders and claimants/beneficiaries.  Responsible for the all life claim processing using knowledge of terminology, procedure, and policy provisions necessary to ensure the timely and accurate adjudication of claims.  This entails policy interpretation, administration, and investigation of claims. This is a high volume production role where timely deadlines are crucial. 

 

Position Responsibilities:

  Adjudicates Group Life Claims routine and complex claims from the first notice of loss to payment. Verifies coverage by reviewing policy provisions and ensures compliance with policies. Obtains backup documentation, as necessary, to substantiate claims by communicating with agents, policyholders, claimants, hospitals, doctors, attorneys, and any other information resources over the telephone, or by written communication. Reviews claim application and related documentation for approval or denial of benefits under established policy provisions. May handle other related duties that include interacting with claimants, and providing technical assistance to other Claims Staff. Requests updated evidence on claims and follows up to ensure receipt of appropriate claim documentation. Operates terminal and printer for data storage and retrieval, including input of claim information into system, including but not limited to claim worksheets and employee records. Assists in special project and assignments related to Payment/Claims services, functions, and objectives and any additional responsibilities as a result of business needs.

 

 

Position Requirements:

  This position requires a detailed knowledge of the company’s established claims processing procedures. Requires independent judgment to settle claims in accordance with policy provisions. Strong verbal and written communication/interpersonal and organizational skills required due to nature of internal and external contacts and exposure to highly confidential information. Requires technical skills to meet company’s goals. Three to four years’ experience in Group Life claims work required.

 

 

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Requires a working knowledge of group products; with a strong emphasis on life insurance. 
Awareness and interpretation of prescribed claims procedures, special settlement options, and company practices. 
Complete understanding of calculation of interest, knowledge of claims procedures, and awareness of Federal and State regulations governing claim and settlements. 
Strong communication skills required. 
Ability to understand, operate, and analyze the various systems and tax laws, as well as life insuance payment systems required.  Must be able to manage time and assist in the training of staff.