Remote Senior Claims Examiner

Job Summary

The Senior Claims Examiner works in conjunction with Fidelity Life’s third-party administrator and the Claims Manager to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The examiner is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines.

• Communicate effectively and respectfully with customers, attorneys, and co‑workers via phone, e‑mail, online chat, and in person.
• Review newly reported claims and log them on the pending claims log.
• Document each claim file thoroughly in accordance with departmental procedures, noting claim review, information obtained, and final decisions.
• Review and interpret insurance policy provisions to ensure accurate and timely claim decisions.
• Review adverse decisions or those beyond authority limits with the Claims Manager, consulting the Legal Department as needed.
• For claims within the Senior Claims Examiner’s authority limit (500,000), confirm benefits and statutory interest are calculated correctly.
• Respond to inquiries from customers and attorneys regarding claim matters, consulting the Claim Director and/or Legal Department as needed.
• Work with Fidelity Life’s Underwriting Department on contestable claim referrals and other complex claims as needed.
• Handle and log specific State and NAIC policy locator searches.
• Mentor and support third‑party claims administration staff.
• Monitor trends in claims experience, escalating issues to management and recommending or implementing corrective actions. Keep management abreast of any trends.
• Work on special projects and other duties as assigned by the Claims Manager.
• Perform quarterly claim audits focusing on third‑party claim handling.
• Assist FLA Sarbanes‑Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams.
• Handle Department of Insurance claim complaints or requests in a timely and professional manner.
• Stay current on all laws, regulations, and industry updates that impact claim handling and compliance.
• Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests.
• Participate in continuous improvement initiatives and suggest proactive changes to operations based on data‑driven insights.
• Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact.
• Support M&A activity, if applicable.

• 5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred).

• Knowledge of medical terminology, regulatory compliance (unfair claims practices, privacy requirements).
• Ability to meet deadlines while performing multiple functions.
• Proficiency in MS Office applications and the Internet.
• Ability to proactively analyze and resolve problems.
• Attention to detail.
• Flexibility and willingness to adapt to changing responsibilities.
• Excellent written communication, interpersonal and verbal skills.
• Basic mathematical calculations (addition, subtraction, multiplication, division, percentages).
• Proactive and outside‑the‑box thinker.
• Independent and organized work style.
• Ability to maintain strong performance while working remotely and independently, if applicable.
• Strong judgment and discretion when handling confidential information.
• Team player and creative, critical thinker highly desired.

• Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required.
• Legal or Paralegal Certifications optional but useful.

• This position primarily involves remote desk work, requiring the ability to remain in a stationary position for extended periods of time.
• Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential.
• Must communicate effectively in virtual and in‑person settings, including video calls, phone calls, and written correspondence.
• Occasional travel (estimated 1–3 times per year) for in‑person meetings, conferences, or vendor visits;…