The Claims Examiner (Part time 20 hours per week between the hours of 8am-4:30pm)examines all claims in assigned states and grants final approval of claims within limits. The Claims Examiner also recommends payments beyond limits and recommends claim denials.
Essential Duties
1. Examine claim type as assigned (Death, Health, Group, Long Term Care). Calculate and pay
benefits due within designated authority limits.
2. Review death claim notices in assigned states and analyze entire policy file to verify rightful payee
and release appropriate claim forms. Authorize $5,000, $10,000, $15,000 or $20,000 immediate
payments to beneficiaries when appropriate requirements are met.
3. Determine the need for, order and monitor contestable, accidental death benefit and health claim
investigations.
4. Communicate daily with agency force, insureds, beneficiaries, law enforcement authorities,
investigative agencies, attorneys, reinsurance companies, funeral homes, medical offices, etc.,
regarding claims.
5. Handle problem claims and conflicts when necessary.
6. Confer with legal counsel on adverse claims/claims requiring litigation.
7. Follow up on pending claims.
8. Approve correspondence prepared by the Intake Specialist and/or Claims Service Representative.
9. Maintain complete and accurate documentation of claim files.
10. Give depositions and court testimony in claim related litigation when necessary
Bachelor's degree or combination of education and comparable experience
Experience/Competencies
• Basic insurance knowledge preferred
• Prior customer service experience preferred
• Basic computer knowledge
• Excellent judgement and communication skills (oral and written)
• Ability to Multi-task
• Excellent organizational skills
• Ability to function effectively in the workplace as exhibited through one's integrity, courage to act
and communication skills
• Ability to work with others effectively as exhibited through one's respect for people and
commitment to teamwork
• Ability to meet organizational goals and customer expectations as exhibited through one's
accountability for results, commitment to service and initiative
• Ability to perform the essential functions of the job as exhibited through one's growth in job
knowledge and professional development
