Claims Examiner II
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Job Location:
Houston, MS - USA
Monthly Salary:
Not Disclosed
Posted on:
19 hours ago
Vacancies:
1 Vacancy
Job Summary
- Review investigate and adjudicate life accidental injury & death simple annuity and rider claims (including disability waiver and accelerated benefit claims).
- Analyze claim documentation policy contracts statutory requirements and determine accurate claim outcomes within authority limits.
- Refer claims exceeding authority to senior claims staff.
- Calculate benefits and applicable statutory interest.
- Communicate with claimants beneficiaries legal representatives and other stakeholders via phone email and written correspondence.
- Conduct interviews with beneficiaries or next of kin when needed.
- Prepare clear written communications including adverse decision letters.
- Provide secondary signature approval and guidance to less-tenured claims examiners.
- Interpret insurance policies contract language and reinsurance guidelines.
- Refer cases to reinsurance when required by treaty terms.
- Represent claims department in legal processes if necessary.
- Maintain accuracy compliance and proper documentation.
- Participate in team projects and assist with other claims as assigned.
- Support team goals and foster a collaborative environment.
Qualifications :
Education & Experience
- Associate degree medical certification or equivalent work experience required.
- Minimum 3 years of experience in life/health insurance claims or related field.
- Experience in life insurance underwriting preferred.
- Understanding of medical conditions legal and financial risk factors preferred
Certifications (Required Timelines)
- Completion of industry insurance coursework required after hire:
- LOMA 281 & LOMA 291 within 12 months
- ALHC designation within 24 months
Technical & Regulatory Knowledge
- Strong understanding of life accident annuity and health insurance products.
- Knowledge of HIPAA privacy standards industry regulations and Unfair Claims Settlement laws.
- Familiarity with insurance and medical terminology.
- Proficient in Microsoft Word Excel and web-based applications.
- Ability to perform mathematical calculations (percentages interest etc.).
Additional Information :
All your information will be kept confidential according to EEO guidelines.
EEOC and Veteran Documentation
During employment employees are treated without regard to race color religion sex national origin age marital or veteran status medical condition or handicap or any other legally protected status.
At times government agencies require periodic reports from employers on the sex ethnicity handicap veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping reporting and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information please note that all
Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file.
Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.
Remote Work :
Yes
Employment Type :
Full-time
Key Skills
- Auditing
- GAAP
- Military Experience
- Phlebotomy
- Conflict Management
- Vital Signs Experience
- Computer Forensics
- Research Experience
- Securities Law
- Operating Systems
- PTSD Care
- RMF
About Company
Sutherland is seeking an organized and reliable person to join us as Admin Specialist. We are a group of driven and supportive individuals. If you are looking to build a fulfilling career and are confident you have the skills and experience to help us succeed, we want to work with you ... View more
