Evaluate and analyze documentation for claim payments or denials according to the policy/certificate provisions and state regulations, with increased authority limits.
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.
Assist peers with processing questions in the absence of higher level staff.
May serve as a back up to review and authorize pending payments calculated by peers, within approval authority.

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

Competitive Pay
Bonus for Eligible Employees
Benefits Package
Pension Plan
401k Match
Employee Stock Purchase Plan
Tuition Reimbursement
Disability Insurance
Medical Insurance
Dental Insurance
Vision Insurance
Employee Discounts
Career Training & Development Opportunities
Health and Work/Life Balance Benefits
Paid Time Off starting at 160 hours annually for employees in their first year of service.
Ten (10) paid holidays per year (typically mirroring the New York Stock Exchange (NYSE) holidays).
Be Well Company holistic wellness program, which includes Wellness Coaching and Reward Dollars
Parental Leave – fifteen (15) days of paid parental leave per calendar year to eligible employees with at least one year of service at the time of birth, placement of an adopted child, or placement of a foster care child.
Adoption Assistance
Employee Assistance Program
Back-Up Care Program
PTO for Volunteer Hours
Employee Matching Gifts Program
Employee Resource Groups
Inclusion and Diversity Programs
Employee Recognition Program
Referral Bonus Programs

Senior Claims Examiner

Key skills