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Posted February 26, 201
Job Title: Claims Examiner II - Prosperity Service Group, LLC
Department: New Business, Underwriting, and Claims
Reports To: Manager, Claims Processing
FLSA Status: Non-Exempt
Examines, investigates, summarizes and approves or recommends action on non-contestable and contestable individual life, annuity, disability to include policy maintenance, tax reporting and benefit distribution.
Major Duties and Responsibilities
- Timely, accurate administration of individual life, annuity, disability and contract payout claims.
- Examines, summarizes and approves non-contestable and contestable life, annuity, disability and contract payout claims within authorization guidelines or makes recommendations to management based on the review of all necessary claim forms or documents, medical records, lab reports, medical reports, police and accident reports and other investigative reports.
- Accurately process non-contestable and contestable claim payments for individual life, annuity, disability and contract payouts according to the established procedures and claim settlement interest guidelines.
- Assist Claim Examiner I with complex life and disability claims.
- Make appropriate adjustments to facilitate accurate 1099 and 5498 reporting.
- Process reinsurance notifications and submit/process requests for reinsurance reimbursements. Correspond with claimants, funeral homes/funding companies, and various medical providers. Observe appropriate confidentiality in communicating all sensitive claim information.
- Maintain a working knowledge of claim examination practices by participating in claim educational programs.
- Maintain a high degree of knowledge regarding fair claim settlement practices, misrepresentation guidelines, delayed settlement interest guidelines and established claim examination procedures.
- Participate as a project team member for the implementation of new products, systems or process/procedures. Interface with service providers to ensure claim processing remains cost effective.
- Other duties as assigned.
Bachelor's degree (B.A.) from a four-year college or university; or equivalent combination of education and experience. Minimum of four (4) years life or disability claim examination experience. ALHC (Associate Life/Health Claims) is preferred but not required.
Work requires the ability to read and interpret documents such as procedure manuals and operating instructions. Ability to write routine reports and correspondence. Intermediate experience or knowledge in the use of Microsoft Office (Word, Excel, PowerPoint), Query or other industry specific software. Must be a good team worker with the ability to handle multiple responsibilities. This job requires the proficiency to read, analyze and summarize medical records, lab tests and other medical studies. The incumbent is required to formulate decisions and recommendations based on these factors. Knowledge and understanding of medical terminology preferred but is not required. Must have good organizational skills. Must be able to pay close attention to details and have good reasoning and decision making skills.
While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
To apply for this job: Go to https://www.prosperitylife.com/careers, and reference job number 0131-19.