Senior Claims Examiner

Role Overview

• Process annuity death claims from initial notification through final payment, including beneficiary validation, documentation review, adjudication, and payment authorization
• Validate contract provisions, ownership, beneficiaries, and required documentation to achieve good order
• Determine claim eligibility and settlement options in accordance with policy/contract terms
• Ensure compliance with regulatory, legal, and internal policy requirements, including time-sensitive claim and payment standards
• Request, track, and evaluate outstanding requirements; document pending reasons and next steps clearly
• Process payments, reissues, adjustments, and reversals as needed
• Review and resolve reopens, referrals, and NIGO items in accordance with established adjudication and quality procedures
• Resolve discrepancies, exceptions, and complex claim scenarios; escalate trends/defects/process gaps as appropriate
• Document claim decisions and actions thoroughly in core systems to support downstream processing, reporting, and audit readiness
• Manage assigned workloads using Salesforce-based claims platforms and related systems, prioritizing work to meet service-level and regulatory commitments
• Respond to internal inquiries, advisor questions, and beneficiary escalations
• Meet productivity, quality, and timeliness goals, recognizing expectations may evolve as technology and process improvements are implemented
• Collaborate with Contact Center partners, Operations leaders, Technology teams, external vendors, and other business partners
• Participate in quality reviews, audits, and continuous improvement efforts by identifying inefficiencies, recommending solutions, and adopting new tools and workflows
• Leverage AI tools, including Copilot, to improve efficiency, accuracy, and decision-making
• Demonstrate adaptability and resilience during periods of change, including system migrations, process redesigns, and volume fluctuations

Requirements

• High school diploma or equivalent
• 2+ years of experience in insurance, annuities, claims, or financial services operations
• Strong attention to detail, analytical skills, and sound decision-making
• Ability to interpret contract language and procedural guidelines
• Strong written and verbal communication skills
• Ability to manage multiple claims and deadlines simultaneously
• Proficiency with case management and workflow systems.
• Demonstrated adaptability and willingness to work through change.
• Experience with annuity death claims or beneficiary services (Preferred)
• Experience working in Salesforce-based platforms or other CRM/claims systems (Preferred)
• Knowledge of annuity products, settlement options, and tax considerations (Preferred)
• Experience working in a regulated environment (Preferred)
• Familiarity with quality controls, audits, or compliance reviews (Preferred)
• Experience working with productivity metrics, quality standards, or performance scorecards (Preferred)
• Comfort using AI-enabled tools (e.g., Copilot) or automation to improve efficiency and effectiveness (Preferred)

Benefits

• Medical, dental, vision, life insurance, disability insurance
• Paid Time Off (PTO)
• Leave of absences, such as parental and military leave
• 401(k) plan with company match (up to 4%)
• Company-funded pension plan
• Wellness Programs including up to $1,600 a year for reimbursement of items purchased to support personal wellbeing needs.
• Work/Life Resources to help support topics such as parenting, housing, senior care, finances, pets, legal matters, education, emotional and mental health, and career development.
• Education Benefit to help finance traditional college enrollment toward obtaining an approved degree and many accredited certificate programs.
• Employee Stock Purchase Plan: Shares can be purchased at 85% of the lower of two prices (Beginning or End of the purchase period), after one year of service.
• Eligibility to participate in a discretionary annual incentive program is subject to the rules governing the program, whereby an award, if any, depends on various factors including, without limitation, individual and organizational performance.