Analyzes and investigates claims to ensure compliance and timely payment of benefits. Responds to agents and policyholders regarding pending claims and appeals. Processes complex beneficiary and ownership changes and approves eligibility of waivers for life and disability income policies. Collaborates with peers and management to ensure consistent interpretations of policies and claim payment methods.
Essential Functions:
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Analyzes, investigates, and adjudicates individual/group life, annuity, and critical, chronic, and terminal illness claims to ensure the timely and accurate payment of contract benefits.
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Obtains reports, medical records, eligibility, and/or additional information required to investigate and process claims.
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Prepares filings for all life reinsurance benefits and tracks status of payments.
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Ensures that claims are in compliance with state and federal mandates and reviews for red flags associated with potentially fraudulent claims.
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Responds to all agents’, policyowners’ and beneficiaries’ written, telephone and email inquiries regarding benefit information, pending claims, paid claims, and appeals.
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Ensures all communications are compliant with state timeliness requirements and federal privacy standards.
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Processes complicated beneficiary changes and ownership changes after the death of owner by working with family members on the legislative issues.
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Investigates pre-existing health information and determines if complete and accurate information was provided while determining contestability issues.
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Collaborates with peers and management to ensure consistent interpretations of policy provisions and claim payment methods.
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Reports potential legal matters involving claims to corporate counsel and assists with or responds to insurance department complaints.
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Trains new claims team members and assists current claims staff with processing issues.
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Approves eligibility of waiver of premium (WOP) claims relating to individual and group life policies and monitors ongoing disability status.
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Documents claims procedures and maintains the claims administration manual as assigned by the Claims Manager.
Education & Experience:
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Bachelor’s degree, preferably in insurance or business administration, or equivalent relevant experience
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Three years of experience in life, annuity and/or health claims, or related experience
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LOMA and/or International Claims Association (ICA) certifications preferred
Knowledge, Skills, & Abilities:
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Strong knowledge of life, annuity, WOP, contestable, and critical/chronic claims processing including federal and state regulations and tax legalities
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Good knowledge of medical and legal terminology
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Strong computer knowledge of Microsoft Suite, Outlook, Access, and insurance administration systems
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Excellent verbal and written communication skills
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Strong math and analytical skills
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Good investigative and problem-solving abilities
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Excellent organizational and customer service skills
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Ability to work in a fast-paced team environment
Per the Colorado Equal Pay for Equal Work Act, the hiring range for this position for Colorado-based team members is $58,618.44 - $75,262.27. The hiring range for other locations may vary.
Our employment practices are in accordance with the laws that prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws.
All of our locations are tobacco free including in company vehicles.
