Senior Claims Examiner

Job Summary

This position interacts routinely with the Actuarial department, Legal department, service personnel at third party administrators, outside vendors, and claimants. This individual is responsible for handling inbound claims phones calls. This position has no supervisory responsibilities.

Duties and Responsibilities

• Process incontestable life and annuity claims for payment or denial
• Process non-financial tasks associated with contestable life claims
• Process payment and denial of claims
• Communicate professionally with claimants, agents, attorneys, vendors, customer service representatives, investigators, law enforcement officials, and medical providers to ensure the prompt handling of claims, to keep interested parties apprised of the status of claim investigations, and to explain claim decisions
• Maintain claim registers for accurate financial reporting of pending, paid, and denied claims. Assists in generating department metrics and reports
• Provide SME to peers including but not limited to handling escalated calls or providing inbound call center training and/or quality monitoring
• May update procedures, training materials, perform quality audits, or create complex correspondence related to claims
• Maintain complete and accurate documentation of claim files

Experience and Education Requirements

• College degree or equivalent experience preferred
• 2+ years of insurance experience in customer service or 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
• Demonstrates ability to build new skills and adapt to new ways of thinking
• Builds knowledge of customers through collaboration and communication
• Develops and maintains goal-oriented, collaborative and productive, team-driven relationships
• Reads verbal, non-verbal and written cues; effectively adjusts communication style to suit the needs of different audiences and situations
• Promotes new ideas and ways of working; suggests new techniques, methods and practices
• Demonstrates proficiency in digital techniques, methods, and tools used at F&G
• Develops and sustains effective working relationships with a wide range of stakeholders, including team members, virtually and in-person
• Logically organizes information to identify connection and form a multidimensional view
• Seeks challenging assignments and projects
• Understands and demonstrates commitment to the departmental vision, strategy, change initiatives and goals
• Demonstrates awareness of workload and shares updates on availability with manager
• Monitors, measures and assesses processes to determine areas of improvement; identifies and eliminates operational waste
• Understand data and communicates the meaning to managers and executives
• Owns responsibility for timely production of deliverables
• Understands expectations for interaction with vendors for their functional area
• Assists in deliverable management and coaches junior team members on quality solution delivery
• Proactively seeks to continue development of knowledge of the regulatory environment and able to share this information with team members

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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