Job Description: Our life insurance client is seeking an experience Life and Waiver Claims Examiner.This is a hybrid position with the option to work in the office in Illinois, Texas or Maine. Under minimal supervision, you will be responsible for reviewing and processing of life claims for group insurance policies on the waiver team. The role involves various duties, including timely follow-up, accurate assessment of supporting information,appropriate adjudication of these claims with optimum outcomes and customer service.Responsibilities:
- Adjudicate claims in accordance with group policy provisions.
- Review, research, verify and obtain information on all claims assigned to determine eligibility for benefits.
- Manage assigned large accounts and sensitive groups toresolve customer problems and complaints concerning claims matters,personally handling claims throughresolution.
- Maintain required levels of confidentiality.
- Keep up-to-dateknowledge of policies, statutes,regulations, medical conditions and departmental procedures to ensure proper claims disposition.
- Interpret and administer contract provisions, including eligibility, employee and dependent coverage amounts, late entrants,evidence of insurability, open vs. annual enrollment, definition of total disability, reduction schedules, facility of payment and contestable investigations.
- Consistently adhere to workflow guidelines and established procedures to meet or exceed quality, production, service objectives and performance guarantee standards.
- Investigate and evaluate claims promptly, validate coverage amounts according to contract andprocess payments or denials in accordance with department procedures and compliance with Unfair Claims Practice regulations.
- Document claim file actions and telephone conversations appropriately.
- Communicate effectively with insureds,beneficiaries, attorneys, policyholders, reinsurers, State Insurance Department and internal stakeholders, resolving issues via verbal and written communication.
- Provide professional customer service through accurate and courteous telephone interviews, follow-up calls and written correspondence to obtain required information, address customer concerns and resolve situations according to standard operating procedures.
- Utilize department resources, reports and system functionality to manage assigned work in a timely manner.
- Proactively identify inconsistencies in claim information and useeffective methods to obtain clarification or verification.
- Maintain accurate documentation of claim activities in accordance with established guidelines.
- Examine and analyze life claim information and finalize benefit decisions and payments on claims up to $100,000 aggregate liability, following prescribed procedures.
- Approve or deny claims within department authority limits andreferclaims outside authority or for disputed settlements to a supervisor or manager for review.
- Collaborate with team members and management to identifyand implement improvements, and inform the supervisor of any trends within client companies.
- Coordinatewith the Actuary Department in submittingclaims under the correct reinsurance treaties.
- Maintain records and reports;may analyze data.
- All other duties as assigned
Requirements:
- Bachelor's degree or fouryears of business experience
- 2+ years of claims experience, proficient in processing life claims
- Experience processing claim types such as critical illness/specified disease, wellness benefit, accidental insurance, GAP, accidental death and dismemberment and accelerated death benefits
- Proficiency in MicrosoftWord, Excel and Outlook
- Strong math aptitude andcritical thinking skills.
- Good decision-making ability, with experience analyzing complex claim information
- Excellent customer service skills
- Clear and concise verbal and written communication skills
- Strong problem-solving and research skills
- Ability to manage multiple tasks and prioritize effectively
- Detail-oriented, maintaining highaccuracy while meeting productivity targets in a fast-paced environment
- Knowledge of state regulations, statutes and ERISA in reference to life and waiver of premiums
Contact:Morgan Falck+1 (312) ###-####...@jacobsononline.comRefer a Colleague:Do you know someone who would be interested in this project? Submit your referral directly by emailing the Jacobson contact listed above or submitting them through this form. If your referral is hired for a contract assignment and meets all other eligibility criteria, you will receive a referral bonus!