Life Insurance Claims Evaluator

2 weeks ago

Fremont, Michigan, United States Western & Southern Life Full time

Position Overview:

The Life Claims Assistant plays a crucial role in the evaluation and management of life insurance claims. This position involves assessing claim details and determining the appropriate actions to ensure compliance with policy guidelines, legal standards, and ethical practices.

Key Responsibilities:

  • Conduct thorough reviews and analyses of life insurance claims, authorizing payments in accordance with established authority limits.
  • Assess claim information to determine the best course of action, ensuring alignment with policy provisions and legal requirements.
  • Engage in direct communication with policyholders, beneficiaries, medical professionals, and legal representatives, requiring a tactful and persuasive approach to resolve issues.
  • Provide expert guidance and support to team members, identifying trends and opportunities for process improvements.
  • Offer insights on general claim policies and address specific claim-related inquiries, focusing on the validity of claims and interpretation of policy language.
  • Fulfill additional duties as assigned, adhering to all organizational policies and standards.

Qualifications:

  • High School Diploma (Required)
  • A minimum of 2 years of relevant experience in claims processing (Required)
  • Strong understanding of medical terminology and conditions.
  • Ability to effectively manage interactions with external clients, demonstrating patience and diplomacy.
  • Excellent verbal and written communication skills for preparing formal and informal correspondence.
  • Proven analytical skills to investigate and summarize complex claim issues accurately.
  • Strong organizational abilities with a focus on prioritization and multitasking.
  • In-depth knowledge of compliance requirements in life insurance.
  • Familiarity with life and health claims processes.
  • Effective problem-solving capabilities.
  • High level of integrity and trustworthiness.
  • Competence in using standard office software and advanced PC skills.
  • Willingness to pursue additional training or educational courses for professional development.

Work Environment:

  • This role is primarily office-based, requiring prolonged periods of sitting and working at a desk or computer.
  • May involve extended hours during peak periods or special projects.

Travel Requirements:

  • No travel is required for this position.

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