Claims Examiner

Job Summary

To support the adjudication of complex life and health claims, the full-time remote Claims Examiner will independently evaluate higher-risk claims, provide technical guidance to Claims Representatives, and manage documentation and investigations while ensuring compliance with contractual and regulatory requirements.

Key responsibilities

• Independently evaluate and resolve complex, contestable claims and prepare recommendations for management approval
• Communicate with various stakeholders regarding claim requirements, status, and resolution while managing pending claims within timeframes
• Analyze medical records and other documentation to determine liability and appropriate settlements, while identifying and assessing fraud indicators

Required qualifications

• Bachelor's degree or equivalent combination of education and relevant experience preferred
• Minimum of three years of progressively responsible life claims experience, including complex claim adjudication
• Advanced knowledge of life insurance contracts and claims procedures required
• Advanced insurance education or credentials, such as ALMI or ACS, preferred
• Demonstrated proficiency in handling complex claims, including contestable and fraud-related matters