Sr. Claims Examiner

This is a Fully Remote Job 1. About Our Client:The organization operates within the financial services industry, providing insurance, retirement, and investment solutions to millions of customers. It addresses the challenge of enabling individuals to plan and achieve financial freedom by offering diverse products including life insurance, annuities, employee benefits, and retirement plans. The company is part of an international financial services group serving approximately 23.9 million customers worldwide. 2. About the Opportunity:The Sr. Claims Examiner plays a critical role in evaluating and analyzing claims documentation to determine payment or denial according to policy provisions and state regulations. This position ensures accurate claim processing, manages claim reviews including interaction with external parties, and maintains compliance with regulatory standards. The role impacts the organization by safeguarding proper claims administration and supporting fraud detection efforts. 3. Responsibilities:Analyze claim documentation to determine the review process and gather additional information as needed.Manage claim reviews and coordinate with external sources.Document all correspondence and communications.Communicate with claimants, medical providers, examiners, and law enforcement verbally and in writing.Collaborate with management, legal counsel, medical directors, and other departments on contested claims.Monitor claims for potential fraud and take appropriate action.Ensure compliance with relevant regulations.Provide testimony in legal proceedings regarding claims when required.Assist peers with inquiries in the absence of senior staff.Serve as backup for reviewing and authorizing payments within approval authority. 4. Requirements:Associate’s degree in a business field or equivalent experience.Five years of claims experience.In-depth knowledge of life and annuity product provisions and related regulatory compliance.Strong communication and customer service skills.Organizational, analytical, and problem-solving abilities.Capacity to learn additional products through cross-training.Ability to multitask and adapt to change. 5. Pay Range and Compensation Package:Salary generally ranges between $48,000 and $53,000, depending on qualifications and operational needs.Eligibility for an annual bonus based on company bonus plan and individual performance. Equal Opportunity Statement:Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:TalentHop is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.