Investigative Claims Examiner

Job Summary

This position is responsible for the adjudication of contestable life and disability claims, accelerated benefit

claims, critical illness claims, and complex incontestable life, annuity and disability claim. This position does

not have direct supervisory responsibilities.

Duties and Responsibilities

• Investigate, in a thorough, timely, and cost-effective manner, all contestable life, disability, annuity and complex incontestable claims to determine the extent of liability and the appropriateness of payment or denial of the claim
• Process payment, perform payment reviews and quality, and denial of claims and rescissions of policies
• Provide leadership, help build teamwork, and offer mentoring to other members of the claims staff
• Handle claims escalations and provide response via phone, email, and/or outbound written correspondence
• May serve as conduit between team and legal and compliance department, vendors, and internal departments
• Perform quality audits and call monitoring, document results, and provide direct feedback and training to other members of the claim staff
• Maintain claim registers for accurate financial reporting of pending, paid, and denied claims
• Maintain complete and accurate documentation of claim files
• Support company or team initiatives either directly or indirectly.

Experience and Education Requirements

• Bachelor's degree or equivalent experience required
• 3+ years of experience investigating contestable life and/or disability claims
• LOMA and/or ICA coursework preferred.

Skills and Abilities

• Understands how the functional units interact with each other; recognizes business changes within coverage area and the impact
• Quickly processes information and develops solutions in real-time, with practical, measurable business benefits (i.e., thinks on one’s feet)
• Proactively identifies opportunities to serve the customer
• Works with other colleagues and leaders deliver Operations strategy
• Reads a wide range of audiences and situations and quickly adjusts communication style accordingly; selects the appropriate communication channel and tone to deliver tough messages
• Identifies opportunities to use innovative processes
• Ability to coach and mentor colleagues on digital techniques and accelerators used at F&G
• Seeks opportunities to cultivate relationships with established contacts in their network
• Provides guidance on what information to gather to achieve business objectives and how to efficiently obtain information that is not easily available
• Seeks challenging assignments and projects
• Understands and demonstrates commitment to the departmental vision, strategy, change initiatives and goals
• Proactively identifies opportunities to improve department performance and escalates ideas to leadership
• Monitors, measures, and assesses processes to determine areas of improvement; identifies and eliminates operational waste
• Understands data and communicates the meaning to managers and executives
• Owns responsibility for timely production of deliverables
• Supports with monitoring of vendor performance; identifies and escalates issues; develops processes to maximize vendor performance
• Demonstrates ability to develop solutions in real time with practical, measurable business benefits; supports long term business unit or department planning
• Maintains industry regulatory knowledge.

Other Requirements:

• Perform other functions, duties and projects as assigned
• Regular and punctual attendance
• Some travel may be required (less than 10%)

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