Life Claims Examiner

Overview

Evaluates claim information and decides appropriate course of action to properly assess, clarify and appraise the claim in compliance with policy provisions, claim procedures, legal requirements and professional ethics.

Responsibilities

What you will do:

• Reviews, analyzes, investigates and authorizes payment of life insurance claims within authority guidelines.
• Evaluates claim information and decides appropriate course of action to properly assess, clarify, and appraise the claim in compliance with policy provisions, claim procedures, legal requirements and professional ethics.
• May communicate directly with policyholders, beneficiaries, hospitals, doctors, attorneys and other internal and external areas. Contacts involve planning and preparation of the communications, requiring skills, tact, persuasion and negotiation to reach resolution.
• Provides technical and professional advice to team members to help meet department objectives. Identifies trends, efficiency and improvement opportunities.
• Provides guidance regarding general claim policy, as well as specific claims problems involving the validity of claim, interpretation of policy contracts and terminology.
• Focuses on individual associate engagement: reduces customer efforts; processes enhancements and identifies LEAN process opportunities
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Bachelor's Degree Or equivalent work experience. - Required
• 3-plus years of relevant experience in claims processing. - Required
• Proven excellent knowledge of basic business processes, workflow and systems. -
• Demonstrated advanced understanding of medical conditions and terminology. -
• Ability to deal effectively with external customers, some of whom will require high levels of patience, tact and diplomacy to diffuse emotionally charged issues and collect accurate information to resolve conflicts. -
• Ability to read, listen and communicate effectively both verbally and in writing to prepare formal and informal correspondence; as well as provide clearly articulate reasons for initiatives, guidance for internal/external customers, instructions, etc. -
• Good level of competence with organization, prioritization and multi-tasking environment. -
• Good judgment with proven ability to accurately investigate, analyze and summarize detailed information to solve complex issues. -
• Understanding of compliance with life insurance and advanced knowledge of life/health claims. -
• Excellent judgment, problem-solving, decision-making and follow-through skills. -
• Ability to coach and mentor both peers and associates. -
• Advanced level of PC skills. -
• High level of candor, trust and integrity. -
• Change agent and proven track record for delivering results. -
• Motivated with the flexibility necessary to operate in a fast growing and fast-paced environment. -
• LOMA Level 1 Certificate (courses: 280/281 and 290/291) Upon Hire - Preferred
• UND 386 Upon Hire - Preferred
• ACS Designation Upon Hire - Preferred
• ALHC Designation Upon Hire - Preferred
• FLHC. Upon Hire - Preferred

Work Setting/Position Demands:

• Works in an office setting and remains in a stationary position for long periods of time while working at a desk, on a computer or with other standard office equipment, or while in meetings.
• Requires the ability to verbally communicate and exchange accurate information to customers and associates on a regular basis.
• Requires visual acuity to read and interpret a variety of correspondence, procedures, reports and forms via paper and electronic documents, visual inspection involving small defects; small parts, and/or operation of machinery (including inspection); using measurement devices continuously. Visual acuity is required to determine accuracy, neatness, and thoroughness of work assigned.
• Requires the ability to prepare written correspondence, reports and forms using prescribed formats and conforming to rules of punctuation, grammar, diction, and style on a regular basis.
• Requires the ability to apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions
• Performs substantial movement of wrists, hands, and fingers for continuous computer work.
• Extended hours required during peak workloads or special projects/events.

Travel Requirements:

• None