Evaluates claim information and decides appropriate course of action to properly assess, clarify, and appraise the claim in compliance with policy provisions, claim procedures, legal requirements, and professional ethics.

What you will do:

• Reviews, analyzes, investigates and authorizes payment of life insurance claims within authority guidelines.
• Evaluates claim information and decides appropriate course of action to properly assess, clarify and appraise the claim in compliance with policy provisions, claim procedures, legal requirements and professional ethics.
• May communicate directly with policyholders, beneficiaries, hospitals, doctors, attorneys, and other internal and external areas. Contacts involve planning and preparation of the communications, requiring skills, tact, persuasion and negotiation to reach resolution.
• Provides technical and professional advice to team members to help meet department objectives. Identifies trends, efficiency and improvement opportunities.
• Provides guidance regarding general claim policy, as well as specific claims problems involving the validity of claim, interpretation of policy contracts and terminology.
• Performs other duties as assigned.
• Complies with all policies and standards.

• High School Diploma (Required)
• 2-plus years of relevant experience in claims processing. (Required)
• Proven advanced understanding of medical conditions and terminology.
• Demonstrated ability to deal effectively with external customers, some of whom will require high levels of patience, tact and diplomacy to diffuse emotionally charged issues.
• Demonstrated ability to read, listen and communicate effectively both verbally and in writing in order to prepare formal and informal correspondence.
• Good judgment with proven ability to accurately investigate, analyze and summarize detailed information to describe claim issues.
• Demonstrated organizational skills.
• Proven understanding of compliance with life insurance.
• Proven knowledge of life/health claims.
• Proven problem-solving skills.
• Proven to have a high level of candor, trust and integrity.
• Demonstrated competence with organization, prioritization and multi-tasking.
• Proven to be a change agent and have proven track record for delivering results.
• Proven to be motivated with the flexibility necessary to operate in a fast-growing and fast-paced environment.
• Advanced PC skills.
• Solid knowledge of standard office software.
• May be required to complete training/educational courses toward the attainment of designations such as ALHC/FLHC, and ACS. Upon Hire (Required)

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