Claims Advisor - Credit

The Claims Advisor is responsible for the accurate and timely review, evaluation, and adjudication of credit-related claims in accordance with contractual provisions, product guidelines, company procedures, and applicable regulatory requirements. This position primarily focuses on analyzing claim documentation, validating eligibility and coverage, interpreting contract provisions, calculating benefits, and determining claim outcomes.

The Claims Advisor exercises sound judgment and attention to detail when approving, adjusting, pending, requesting additional information for, or denying claims. The role requires the ability to review financial and supporting documentation, identify discrepancies or missing information, and make accurate decisions in accordance with established guidelines and authority levels. The Claims Advisor also maintains accurate claims records, supports payment processing, and escalates complex, questionable, or potentially fraudulent claims to leadership as appropriate.

This position handles multiple credit protection products and claim types and is expected to meet established productivity, quality, accuracy, and service standards in a fast-paced production environment.

• High School diploma or equivalent; associate or bachelor’s degree preferred.
• Minimum 2–4 years of experience in claims processing, insurance, credit protection, financial services, banking, loan servicing, healthcare administration, or a related field preferred.
• Experience reviewing contracts, policies, financial records, or supporting documentation preferred.
• Demonstrated ability to analyze information and make accurate, consistent decisions based on established guidelines
• Strong attention to detail with the ability to identify discrepancies, missing information, and inconsistencies within claim documentation.
• Strong organizational and time management skills with the ability to manage multiple claims and priorities while meeting production requirements.
• Ability to handle confidential customer, financial, and claim information with professionalism and discretion.
• Proficient computer skills, including data entry and the ability to navigate multiple systems and applications simultaneously.
• Working knowledge of claims processes, insurance terminology, credit products, loan documentation, or contract interpretation preferred.
• Knowledge of applicable regulatory requirements, compliance standards, and fraud awareness is a plus.

• Reviews and adjudicate credit-related claims by evaluating submitted documentation, product coverage, eligibility requirements, contractual provisions, exclusions, and applicable guidelines to determine appropriate claim outcomes.
• Analyzes loan, account, payment, employment, disability, life, or other supporting documentation, as applicable to the assigned credit product and claim type.
• Determines whether claims meet contractual and procedural requirements for payment, adjustment, pend status, additional documentation, or denial.
• Validates claim information and supporting documentation for completeness, accuracy, and consistency prior to making an adjudication decision.
• Calculates claim benefits, balances, reimbursements, or other applicable payment amounts in accordance with contractual provisions and established procedures.
• Identifies discrepancies, inconsistencies, or missing information and takes appropriate action to obtain clarification or additional documentation.
• Applies established claim authority, procedures, and escalation guidelines when making claim decisions and escalates exceptions or complex claims when appropriate.
• Maintains accurate and complete claim documentation to support claim decisions, payments, audits, regulatory reviews, and…