Job Overview
- Review, investigate, and adjudicate life, accidental injury & death, simple annuity, and rider claims (including disability waiver and accelerated benefit claims).
- Analyze claim documentation, policy contracts, statutory requirements, and determine accurate claim outcomes within authority limits.
- Refer claims exceeding authority to senior claims staff.
- Calculate benefits and applicable statutory interest.
- Communicate with claimants, beneficiaries, legal representatives, and other stakeholders via phone, email, and written correspondence.
- Conduct interviews with beneficiaries or next of kin when needed.
- Prepare clear written communications, including adverse decision letters.
- Provide secondary signature approval and guidance to less-tenured claims examiners.
- Interpret insurance policies, contract language, and reinsurance guidelines.
- Refer cases to reinsurance when required by treaty terms.
- Represent claims department in legal processes if necessary.
- Maintain accuracy, compliance, and proper documentation.
- Participate in team projects and assist with other claims as assigned.
- Support team goals and foster a collaborative environment.
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