Claims Consultant

At Northwestern Mutual, we are strong, innovative and growing. We invest in our people. We care and make a positive difference.

Summary:

The Life Claims Consultant is responsible for assessing and making decisions on life insurance claims, including high-value and suspicious cases, ensuring compliance with a $5M signature authority limit. This role involves analyzing various documents such as death certificates, claim forms, legal documentation, and conducting routine reviews of contestable claims in accordance with contract language and state laws. You’ll provide direction on complex claim referrals, collaborating with various departments such as Law, Underwriting, and Special Investigations.

You must clearly communicate claims decisions and handle disputes or appeals on complex claims, collaborating with legal counsel and participate in depositions as necessary.

Primary

Duties & Responsibilities:

Decision Making and Claims Review

• Preserve Northwestern Mutual's image and reputation in making benefit decisions despite difficult and emotional circumstances.
• Make fair, accurate, and timely decisions on life insurance claims, involving high value policies, suspicious circumstances, and/or newly issued policies within the contestable period, all while maintaining compliance with a $5M signature authority limit.
• Examine and analyze claim information, including beneficiary data, policy values, death certificates, claim forms, assignment forms, divorce decrees, and estate and trust documentation, and other relevant documents.
• Conduct routine contestable claim reviews in accordance with applicable contract language and state laws. Frequently review medical records, pharmacy reports, police reports, medical examiner reports, policy applications, and underwriting assessments.
• Communicate claims decisions to beneficiaries and other parties clearly and sensitively, providing detailed explanations and supporting documentation as needed, often in written form.
• Manage and resolve disputes or appeals related to claims decisions with legal counsel and be prepared to represent the company in legal matters, including depositions and trials.
• Exhibit empathy, professionalism, and tact in all interactions, especially with sensitive or contentious claims.
• Manage phone and transactional responsibilities with a strong commitment to confidentiality.
• Maintain organization, accuracy, and timeliness in case management systems; accurately capture and document claim-related information and/or refer tasks as appropriate.
• Ensure efficiency and accuracy by maintaining production and claim quality standards.
• Facilitate internal and external claim audits as necessary.

Leadership and Collaboration

• Provide direction on claim referrals within the division by sharing knowledge and expertise on complex claim situations that may arise within the scope of the role.
• Collaborate on complex claims with partners in Law, Underwriting, Special Investigations Unit, Reinsurance Administration, Disability Claims, Long-Term Care Claims, Treasury, and Field Client Services.
• Participate in continuous improvement initiatives to enhance claims processes, reduce turnaround times, and improve accuracy.
• Assist with special projects to support the business.
• Embrace and advocate for new technology, educating beneficiaries and field representatives.
• Support digital capabilities and adapt positively to changing environments and new situations.

Qualifications:

• Bachelor’s degree or equivalent combination of education and progressively responsible work experience.
• Experience in claims, underwriting, healthcare, or investigative work is preferred.
• Minimum 4 years management level experience working in insurance operations or a related field.
• High degree of accuracy in handling detailed technical work.
• Self-motivated with proven responsibility for work results and group goals.
• Technically savvy with the ability to toggle between multiple applications and monitors simultaneously.
• Strong organizational skills, able to independently prioritize to meet deadlines.
• Excellent communication skills (both verbal and written) to include the proven ability to negotiate.
• Leadership and decision-making…