Field Claims Consultant

Summary

Field Claim Consultants are remote employees who conduct video, telephone, and in-person interviews (requiring travel), to evaluate and analyze the most complex contestable and non-contestable, Disability Income, Life, Long Term Care and Life Waiver of Premium claims. Interprets, analyzes, and identifies pertinent facts in accordance with policy provisions, state regulations and claims procedures and standards to assist with claim evaluation. Where necessary, consults with the Directors, Assistant Directors of Claims Division, Field Claims Consultant (FCC) Manager or the referring Analysts, Specialists or Consultants to ensure appropriate and timely handling of the claim.

Primary Duties & Responsibilities:

• Acts as a consultant for the DI Claims Department which involves conducting video, telephone and in-person interviews, requiring travel to the insured’s requested location.
• Acts as a consultant to investigate contestable death claims for Life Benefits, which includes conducting phone and in-person interviews with Next of Kin, policyowner, beneficiaries etc.
• Acts as a consultant for the DI Claims Department assisting with settling and negotiating Overpayments of benefits and conducting interview when needed.
• Handle NM Group Claims, LTC, Compliance, Law and other areas of the company, as requested.
• Acts in an investigative capacity leveraging a specialized skillset to assist the SIU with investigations including suspected fraud, diminished capacity, elder abuse, welfare checks and locating missing sources.
• Settlement authority up to $250,000 and can meet in-person with policyowners, insured’s or their legal representatives to negotiate and resolve claims.
• Provide detailed written reports on all interviews conducted, that must be clear, accurate, and concise.
• Preparing and attaching accurate file documentation on claims related to referrals.
• Protection and secure handling of sensitive claim/policy and client information.
• Ability to effectively utilize various claims systems and tools, as part of core work responsibilities. Leverages systems knowledge and software such as (Zoom/ Dragon Naturally Speaking/ LinkedIn, Facebook, Instagram, etc.).
• Acts as a leader, coach, and mentor to collaborate with colleagues to assist in enhancing claims knowledge and field handling opportunities.
• Participate in project work to create efficiencies within the FCC Team to include system and application updates, MK Updates, and other opportunities the team identifies or as requested by Senior Leadership/Management.
• Develop presentations for new analysts on identifying potential claim issues and FCC function. Research and create micro learnings for the Claims Division and deliver presentation for the Annual FCC Summit, Small Team Meetings and Benefits Briefings.
• Continuous education by team members of enhancements of digital systems, contracts, new policy procedures, financial/tax updates.
• Responsible for training new hires as needed. Such training will include interpretation and application of contracts, claim’s philosophy, including virtual and in-person interview techniques, use and applications of company computers, claims systems, and database knowledge.
• Responsible for promoting NM’s brand and image as the face of the company during interactions with policyholders.

The FCC is responsible for:

• Effective claim handling and evaluation of contestable and non-contestable, Disability Income, Life and Accidental Death Benefit, Life Waiver of Premium, Long-Term Care, claims through thorough and timely contact with Policyowners, Insureds, Physicians, business partners, and other parties.
• Skillful collaboration with colleagues across all levels in diverse claims scenarios, including pending, active, terminated, appeals, overpayments, suspected fraud, Carpe Data, CDC’s, diminished capacity, and financial abuse.
• Assist the Law Department and outside counsel when litigating cases through gathering and preparing necessary information and participating in depositions.
• Assist Market Conduct with field investigations when circumstances require FCC involvement.
• Preservation of NM's image and reputation in the obtaining of the necessary facts so as to permit approval, denial, or compromise of claims consistent with NM's claim philosophy, despite difficult and delicate circumstances.
• Participate in the training and performance evaluation of new FCCs. Act as mentor to FCC(s) and other business line customers.
• Act as a resource to the FCC staff on use of the laptop computer and other equipment assigned to them.
• Preparation of timely and thorough written reports of activities performed to assist analysts and managers in administration of the claim or insurance matters.
• Effective resolution of claims through skillful negotiation with policyowners, Insureds or their legal representatives by being sensitive to the rights of the other party, by protecting the Company and its policyholders from overpaying fraudulent or non-compensable claims.

Qualifications:

• Bachelor's degree or equivalent work experience.
• Minimum of 5 years of complex disability or life claims handling experience demonstrating analytical ability, independent decision making and sound judgment, or equivalent analytical experience. Investigative background is desired.
• Excellent written and oral communication skills including the ability to handle complex interpersonal situations.
• Demonstrated ability to work independently, utilizing time management skills to set priorities and complete assignments in a timely manner.
• Adapt quickly and remain agile in response to ongoing changes in digital systems, contracts, financial updates, and tax regulations.
• Proficiency with laptop computers and utilizing software such as MS Office, Word, Excel, Outlook, Zoom, Slack, Dragon, and other technologies.
• Proficiency in conducting research utilizing the internet.
• Ability to travel by air, rail or vehicle and work nights/weekends when required.
• Ability to coordinate and manage travel logistics and expense management related to in-person interviews or other company required activities.
• Completion of industry courses as required by company.
• Demonstrate a high level of integrity.
• Excellent personal financial management and credit history.
• Satisfactory driving record required for travel. Proof of auto insurance is required.