Full-Time Claims Examiner II

• Review, investigate, and adjudicate life, accidental injury & death, simple annuity, and rider 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.

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

• 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.).

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