Claims Examiner

About the role

Claims Examiners are confident decision-makers, playing an important oversight role in the claims process. To process, monitor, review and approve/deny living benefits and death claims.  This includes reviewing medical information and case history to determine if additional investigation is required.  Inform, notify, educate, and communicate with agents, insureds/claimants, beneficiaries, and internal departments. Monitor and maintain claims computer systems and reports for accuracy and efficiency

What you'll do

• Review claims reports and mail.  Analyze investigative material for coverage to determine if claim is to be paid or denied, and if policy/certificate needs to be reformed/rescinded. 
• Maintain contact with agents and corporate legal counsel as needed. 
• Process payments and correspondence on a timely basis to ensure accurate and prompt processing. 
• Review new claims and determine if coverage is in force and claim is valid. Set up file; request additional information needed.  Initial review includes reinsurance participation, contestability, beneficiary designations, coverage exclusions. Conclude what, if any, benefit applies and the amount to be reimbursed.
• Organize work/resources to accomplish objectives and meet deadlines
• Maintain compliance with federal and state regulations
• Maintain the privacy and security of all confidential and protected information; use and disclose only that information which is necessary to perform the function of the job
• Demonstrate the willingness and ability to work collaboratively with other key internal and external staff to obtain necessary information from both internal and external partners.
• Participate in all educational activities and demonstrate personal responsibility for job performance
• Take initiative for learning new skills and willingness to participate and share expertise on projects, committees and other activities, as deemed appropriate
• Consistently demonstrate a positive and professional attitude at work
• Deliver a high standard of service and empathy when following up with customers by letter, email, or telephone once the claim has been resolved.
• Efficiently answer incoming telephone or email inquiries from customers about the status of their claim, striving for excellence at every touchpoint.
• Work with other departments to maintain and update claims systems and ensure accuracy of reports.  Maintain relationships with beneficiaries, agents, insureds/claimants, and creditors.
• Accurately research discrepancies and be responsible for escalating questionable claims to your manager.

Qualifications

Skills/Competencies

• Strong organizational skills with elevated level of attention to detail
• Demonstrated persistency and ability to deliver results under pressure
• Excellent interpersonal, verbal communication and proofreading skills
• Proficient in Microsoft Office, etc.
• Must be a flexible self-starter who can prioritize tasks, follow through and meet deadlines
• Ability to work independently with minimal supervision
• Strong risk assessment and conflict resolution skills.
• Ability to read and interpret contract language  

Physical Demands

• Normal office working environment, full time with some flexibility
• Occasional evening and weekend hours to meet deadlines
• Ability to type / perform data entry
• Ability to read from a computer screen and paper reports
• Express ideas and otherwise communicate with the spoken word