Accumulates, examines, investigates and determines the disposition of life, annuity, health and disability claims. Communicates with a wide range of customers and business professionals such as policyholders, attorneys, physicians, hospital personnel, police departments, employers, State Medicaid personnel, funeral homes, Probate courts and other professionals needed to determine the disposition of claims within authority limits. Coverage decisions made are susceptible to litigation and/or significant monetary damages. In addition to claim processing, handles client support calls. Provides prompt and courteous customer service to external and internal customers, and provides job-specific training for new hires in addition to training on specialized processes. Verifies all requirements before closing claim files on completed claims, codes statistical data related to cause of death and aids in the production of monthly and quarterly reports. Researches and completes projects as assigned.

What you will do:

• Determines proper payees, calculates benefits and releases payment up to $200,000 on life insurance claims, $400,000 on annuity claims, and $25,000 on critical illness claims. Determines the Company's liability using knowledge of policy provisions, medical terminology, disability duration, state regulations and tax requirements, and rules established by the NAIC. Effectively manages and prioritizes workload based on volumes and client need. Able to independently make claim decisions (denials and claim payments) that fall below his or her set authority limit. On cases requiring management approval, completes claim work and makes recommendations on claim decision. Determines when a claim requires review with Company attorneys or management, presenting details of the claim and recommendation for resolution.
• Resolves variable and fixed annuity second-level inquiries received via telephone or written correspondence from contract owners/annuitants or financial representatives. Communicates through clear, concise, and well-constructed written correspondence and verbal communication while conducting and receiving telephone calls with clients and Company personnel in a professional manner. Proactively seeks resolution to client issues; empowered to make independent decisions and uses solid judgment in recognizing the need to escalate situations to management.
• Conducts and controls investigations on contestable, accident, foreign and homicide claims up to $25,000. Exercises independent judgment in defining the nature and scope of the investigation. Selects outside investigation firms when appropriate and manages the costs associated with each investigation. Works directly with our Law department to draft legal releases, affidavits, authorizations and agreements to settle a claim.
• Effectively works as a mentor within a team composed of associates who are at various levels of experience and expertise in addition to various job levels. Assists in the planning, prioritization and support of daily workload within their assigned teams.
• Responds in writing to Department of Insurance complaints, working closely with Compliance. Prepares written responses to customer complaints and inquiries following proper rules of punctuation, grammar, diction and style.
• Is responsible for completing project work as assigned by management. Projects include but are not limited to the following:
• Completes various monthly, quarterly and annual reports for senior management, comptroller, reinsurance carriers and various states. Reviews accounting reports and processes corrections to ensure ledger accuracy and balancing. Reviews and files Errors and Emission (E&O) claims.
• Responsible for identifying and mitigating risks to the Enterprise including, but not limited to, reporting possible fraudulent activity, Anti-Money Laundering, and privacy concerns.
• Maintains compliance with applicable federal and state laws (e.g., HIPAA) related to privacy, security, confidentiality, and protection of personal information, including, but not limited to, personal health information, financial information, and personally identifiable information. Maintains comprehensive knowledge of state regulations and tax requirements that pertain to variable annuity, fixed annuity and life insurance claim processing.
• Performs other duties as assigned.
• Complies with all policies and standards.

• College degree, minimum four years of relevant life insurance work experience, or a combination of education and relevant work experience. 
• Demonstrated experience working independently. Experience must include identifying and resolving problems where independent decision-making and initiative were demonstrated. Must provide examples of working under multiple deadlines and minimal supervision. 
• Proven experience in maintaining a high degree of accuracy associated with high volumes of work and/or multiple duties. 
• Proven experience working in a customer-oriented field and effectively articulating information to clients in a patient and understanding manner while managing multiple tasks.
• Demonstrated experience identifying problems arising from customer, policy/procedural changes, etc., and providing effective recommendations to resolve. 
• Proven experience coordinating multiple projects/assignments simultaneously and completing assigned tasks accurately and on a timely basis. Project management experience in planning, executing and maintaining a project is a plus.  and
• Demonstrated experience effectively influencing a group to a recommended course of action. 
• Commensurate experience as outlined in the selection criteria section. 
• Demonstrated knowledge of claims administration, including fraud investigations, payment options, contract provisions and tax ramifications.
• Demonstrated strong attention to detail with excellent organizational skills. Cite examples of organization and time management methods used to manage or prioritize workload demands.
• Proven strong analytical skills, including demonstrated experience identifying and quantifying problems, and providing effective resolutions when dealing with multiple alternatives.
• Proven flexibility when faced with changes in work procedures; this includes providing examples of grasping and initiating new concepts in the workplace.
• Demonstrated excellent verbal and written communication skills with the ability to convey information to internal and external customers in a clear, concise and professional manner.
• Working knowledge of Microsoft Office applications.
• ALMI (LOMA) Upon Hire
• ALHC (ICA) Upon Hire 

Work Setting/Position Demands:

• Works in an office setting and remains in a stationary position for long periods of time while working at a desk, on a computer or with other standard office equipment, or while in meetings.
• Requires the ability to verbally communicate and exchange accurate information to customers and associates on a regular basis.
• Requires visual acuity to read and interpret a variety of correspondence, procedures, reports and forms via paper and electronic documents, visual inspection involving small defects; small parts, and/or operation of machinery (including inspection); using measurement devices continuously. Visual acuity is required to determine accuracy, neatness, and thoroughness of work assigned.
• Requires the ability to prepare written correspondence, reports and forms using prescribed formats and conforming to rules of punctuation, grammar, diction, and style on a regular basis.
• Requires the ability to apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions
• Performs substantial movement of wrists, hands, and fingers for continuous computer work.
• Extended hours required during peak workloads or special projects/events.

Travel Requirements:

• None