EMC · United States
About the Role
We are seeking a Claims Examiner to join our team. The successful candidate will be responsible for analyzing and investigating claims to ensure compliance and timely payment of benefits.
As a Claims Examiner, you will work closely with agents, policyholders, and peers to resolve claims in a fair and efficient manner.
Responsibilities
Analyzes, investigates, and adjudicates individual/group life, annuity, and critical, chronic, and terminal illness claims to ensure the timely and accurate payment of contract benefits.
Obtains reports, medical records, eligibility, and/or additional information required to investigate and process claims.
Prepares filings for all life reinsurance benefits and tracks status of payments.
Ensures that claims are in compliance with state and federal mandates and reviews for red flags associated with potentially fraudulent claims.
Responds to all agents’, policyowners’ and beneficiaries’ written, telephone and email inquiries regarding benefit information, pending claims, paid claims, and appeals.
Ensures all communications are compliant with state timeliness requirements and federal privacy standards.