Customer Claims Specialist

Job Summary and Objective of the Position

This position works in a team environment to process Life Insurance, Annuity and VUL claims. This position will handle calls from customers, agents, funeral homes, attorneys, etc. Excellent communication skills are required. This position requires someone with
excellent attention to details, organizational skills, time management, knowledge of Life Isurance, Anuuities and VUL, above average computer keyboarding skills and a professional demeanor.

Primary Job Functions

-Contact with teammates, management, and other departments. Requires tact, conflict resolution skills, and the knowledge and experience of the business to provide accurate and informative answers to customer’s inquiries.

-Review and process claim within time goal required.

-Direct phone contact with beneficiaries.

Work Experience, Education, Certification / Training Required

1.Strong background in customer service gained by at least 3 years work or equivalent experience.

2.Strong background in the insurance industry gained by completion of the LOMA Level 1 or equivalent experience

3.High School Diploma

Knowledge, Skills and Abilities Required:

-Process claims – Fully investigates all relevant claim issues, provides prompt payment and in full compliance with departmental procedures, Unfair Claims Practice regulations and in accordance with the terms of the insurance contract and applicable laws. Consistently
communicates status with all appropriate parties involved with the claim. The Examiner is accountable for identifying and evaluating information required to adjudicate claims.

-Answering calls – answering telephone inquiries from backup ACD line concerning claim status, claim filing, reports of death, as well as communicating internally with other departments. Handling of customer complaints from ACD line and document the information
received and telephone conversation into the claim file. Responsible for incoming and outgoing calls to claimants, Powers of Attorney, facilities and other person’s or entities involved in the payment of a claim.

Correspondence – Respond in writing to customer inquiries in accordance with regulations. Review demand letters and responds within individual parameters and escalates as appropriate.

-Research – Verifies policyholder information, policy effective dates, premium status and verification of claim eligibility. Identifies the need for additional information. Contacts appropriate source to obtain needed information. Verifies beneficiary information
and payment amount.

-Approve – Approve claims according to the designated approval authority guidelines

-Assist with Unclaimed Property process.

-Reviews and analyze IRS Form W9 and Form W8.

-Maintain claim file with proper level of documentation.

-Maintain claim inventories within departmental, contractual and regulatory guidelines.

-Has knowledge and is able to work simultaneously with multiple computer systems.

-Able to complete moderately difficult mathematical calculations.

Strong customer service orientation and able to work with customers in a professional and empathetic manner

-Have a strong sense of teamwork. Work harmoniously with peers within a team environment to accomplish both personal and team performance goals.

-Participates as a team member for all system and new product initiatives.

Ability to use independent initiative to seek answers to customer concerns.

Ability to prioritize multiple tasks and meet deadlines.