Evaluate and analyze documentation for claim payments or denials according to the policy/certificate provisions and state regulations, with increased authority limits.

Responsibilities

  • 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.

 

Qualifications

  • 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

 

*Please note that the compensation information that follows is a good faith estimate for this position only and is provided pursuant to applicable pay transparency and compensation posting laws. It is estimated based on what a successful candidate might be paid in certain Company locations.**

 

The salary for this position generally ranges between $45,000 - $55,000 annually. This range is an estimate, based on potential qualifications and operational needs. Salary may vary above and below the stated amounts, as permitted by applicable law.

 

Additionally, this position is typically eligible for an Annual Bonus of 7.5% based on the Company Bonus Plan/Individual Performance and is at the Company’s discretion.