Senior Claims Examiner

Responsibilities

• Analyze information/documentation received to determine how to proceed with a review of a claim and determine methods of obtaining additional information from alternative sources.
• Manage the review of a claim and outside sources used in the review.
• Document correspondence and conversations.
• Correspond verbally and in writing with claimants, medical providers, medical examiners, and law enforcement.
• Work closely with department manager, legal counsel, medical director, claims assistants, and other departments to gather information for contested claims.
• Monitor claims for fraud and proceed according to each situation, such as engaging the Fraud team or conducting additional research.
• Maintain compliance with regulations.
• May testify in depositions, hearings and trials; communicate the Company’s position regarding the claim.
• Aid peers with processing questions in the absence of higher level staff.
• May serve as a backup to review and authorize pending payments calculated by peers, within approval authority.

Qualifications

• Associate’s degree in a business field or equivalent experience
• Five years of claims experience
• In-depth understanding of life and annuity product language, provisions, and regulatory/compliance rules and regulations
• Excellent communication and customer service skills
• Organizational, problem-solving and analytical skills
• Ability to cross train and learn other products
• Ability to multi-task and adapt to change